An analysis of the economic and patient outcome impact of an integrated COPD service in east London

Figures & data

Figure 1 Referrals to the ACERS team.

Notes: Number and reasons for referral to the ACERS team for each quarter (Q1–Q4) of financial years 2011/12–2014/15 (financial years run from April to the following March, so 2011/12 indicates April 2011 to March 2012). The total number of patients seen by the ACERS team from 2011/12 to 2014/15 is nearly 6,000. The number of referrals to the ACERS team has increased over time from 450 in 2011/12 to 2,000 per year in 2014/15. Data were collected from hospital electronic records and RiO. Large numbers of “not recorded” for Q3 and Q4 for 2014/15 are due to a decrease in recording linked with changes to the RiO system (making “reason for referral” a non-mandatory field).
Abbreviation: ACERS, Acute COPD Early Response Service.

Table 1 COPD QOF indicators for City and Hackney, London and England

Indicator	2008	2009	2010	2011	2012	2013	2014
Number of patients on COPD register (QOF) – City and Hackney	2,221	2,267	2,347	2,499	2,654	2,871	2,943
Recorded prevalence of COPD (% of total patient list)
City and Hackney	0.8	0.9	0.9	0.9	0.9	1.0	1.03
London	0.9	1.0	1.0	1.0	1.1	1.1	1.1
England	1.5	1.5	1.6	1.6	1.7	1.7	1.8
% of COPD diagnoses confirmed by spirometry
City and Hackney	–	88	90.9	93.2	94.1	94.1	94.1
London	–	89.3	89.4	88.8	92.5	91	90.2
England	–	90.4	90.3	89.7	93.2	91.3	90.7
% of COPD patients with a FEV1 measurement in last 15 months
City and Hackney	82.5	81.5	86.5	88	89.3	90	90.8
London	84.3	81.1	87.5	87.8	88.1	88.1	86.7
England	84.4	82.5	88.5	88.8	88.8	88.4	86.3
% of COPD patients with a breathlessness assessment in last 15 months
City and Hackney	–	–	89.2	92.1	93.9	91.8	95.3
London	–	–	89.7	91.2	91.4	91	90.9
England	–	–	89.9	91.6	91.8	91.1	89.6
% of COPD patients who have had flu vaccine
City and Hackney	92	91.4	91.9	93.1	93	91.1	95.4
London	95.2	91.8	93	93.1	93	91.7	94.7
England	94	91.7	92.7	93.2	93.1	92.7	96.2

Notes: –Indicator not in use for this year. Data from Primary Care Mortality Database. Available from: http://content.digital.nhs.uk/pcmdatabase. Accessed November 15, 2015. Copyright © 2015, Re-used with the permission of the Health and Social Care Information Centre, also known as NHS Digital. All rights reserved.¹⁸

Abbreviations: QOF, quality and outcomes framework; FEV₁, forced expiratory volume in 1 second.

Table 2 Admissions and time spent in hospital for admissions for COPD

Metric	Pre-ACERS mean value	Post-ACERS mean value	Sample size (n)	P-value	Change	Effect size
COPD admissions (City and Hackney patients to all trusts)	1.38 per 1,000 population	1.24 per 1,000 population	7	0.13	Nonsignificant reduction
COPD admissions (City and Hackney patients to the Homerton Hospital only)	1.07 per 1,000 population	0.99 per 1,000 population	7	0.34	Nonsignificant reduction
% of COPD admissions which are 0–1 days	27%	34%	7	<0.0001	Significant increase	1.19
Average LOS for COPD admissions	6.8 days	4.5 days	7	0.07	Almost significant decrease	1.74
Total bed days for COPD	1,817 per year	1,200 per year	7	0.048	Significant decrease	2.00

Abbreviations: ACERS, Acute COPD Early Response Service; LOS, length of stay.

Figure 2 Rate of admissions to hospital for COPD.

Notes: The number of admissions to hospital (any trust) for London CCG areas (ONS group London Cosmopolitan) for COPD (primary reason for admission) per 1,000 population (ONS resident population data) over time. Admissions have decreased in City and Hackney between 2007 and 2014. Financial years run from April to the following March, so 2007/08 indicates April 2007 to March 2008, etc. Admissions data from HES. Information on HES data available at: http://content.digital.nhs.uk/hes. Accessed April 15, 2015. Copyright © 2015, Re-used with the permission of the Health and Social Care Information Centre, also known as NHS Digital. All rights reserved.¹⁷
Abbreviations: CCG, Clinical Commissioning Group; ONS, Office for National Statistics; HES, Hospital Episode Statistics.

Figure 3 LOS in hospital for COPD admissions.

Notes: HES data on length of inpatient hospital stay for COPD admissions to Homerton Hospital (by City and Hackney residents only). For each period, percentage of all admissions that were short stay (0–1 day), medium stay (2–5 days) or long stay (6 or more days) are shown. Line shows the percentage of all episodes with an LOS that was 0 days or 1 day. This proportion increases over time with the introduction of the ACERS team. Financial years run from April to the following March, so 2007/08 indicates April 2007 to March 2008, etc. Data from HES. Information on HES data available at: http://content.digital.nhs.uk/hes. Accessed April 15, 2015. Copyright © 2015, Re-used with the permission of the Health and Social Care Information Centre, also known as NHS Digital. All rights reserved.¹⁷
Abbreviations: LOS, length of stay; HES, Hospital Episode Statistics; ACERS, Acute COPD Early Response Service.

Figure 4 Hospital bed days for COPD admissions.

Notes: Total bed days spent by City and Hackney residents due to COPD admissions at the Homerton Hospital. Total bed days and number of admissions are shown for each period, along with average LOS per patient (calculated from number of bed days per admission). The total bed days have decreased between 2007 and 2014. Financial years run from April to the following March, so 2007/08 indicates April 2007 to March 2008, etc. Data from HES. Information on HES data available at: http://content.digital.nhs.uk/hes. Accessed April 15, 2015. Copyright © 2015, Reused with the permission of the Health and Social Care Information Centre, also known as NHS Digital. All rights reserved.¹⁷
Abbreviations: HES, Hospital Episode Statistics; LOS, length of stay.

Table 3 Percentage of deaths in hospital and out of hospital (deaths from COPD only) following the introduction of the ACERS team

Period	Hospital deaths, n (%)	Non-hospital deaths, n (%)
Pre-ACERS	161 (76)	51 (24)
Post-ACERS	104 (58)	76 (42)

Notes: Data from Primary Care Mortality Database. Available from: http://content.digital.nhs.uk/pcmdatabase. Accessed November 15, 2015. Copyright © 2015, Reused with the permission of the Health and Social Care Information Centre, also known as NHS Digital. All rights reserved.¹⁸

Abbreviation: ACERS, Acute COPD Early Response Service.

Figure 5 Place of death for deaths from COPD and all deaths.

Notes: ONS data on place of deaths for City and Hackney residents for all causes of death and deaths from COPD alone. Graph shows the proportion of deaths in hospital and out of hospital (covering home, hospice and others). The proportion of deaths occurring in hospital has decreased over time for all causes of death, but the proportion of deaths from COPD that occur in hospital has decreased at a faster rate. Financial years run from April to the following March, so 2007/08 indicates April 2007 to March 2008, etc.
Abbreviation: ONS, Office for National Statistics.

NHS Digital. Health and Social Care Information CentrePrimary Care Mortality Database Available from: http://content.digital.nhs.uk/pcmdatabaseAccessed November 15, 2015

 Google Scholar

NHS DigitalHospital Episode Statistics Information on HES data available at: http://content.digital.nhs.uk/hesAccessed April 15, 2015

 Google Scholar