Integrated Multidisciplinary Community Service for XXXX Reduces Hospitalisations.

@entity1 @entity55 @entity1030
BACKGROUND: Hospitalisations for @entity1030 exacerbation effect @entity1 outcomes and healthcare costs. The long-term impact of an integrated @entity1030 disease management approach on hospitalisation remains controversial. AIM: This study evaluated whether a multi-disciplinary community service reduces respiratory hospitalisations for @entity1030 @entity1 . METHODS: 346 @entity1 were followed for a mean duration of 27.3 months. The number of admissions, total bed days for respiratory ( @entity55 ) or general medical causes and length of stay per respiratory admission were compared before and after referral to the service. Secondary multivariate analysis examined which clinical parameters best predict benefit from such service. RESULTS: Total respiratory admission and hospital bed days after referral were reduced by 31% (288 vs 417, p<0.001) and 40.4% (1637 vs 2746, p<0.0001) respectively compared to the equivalent duration prior. The average length of stay for each respiratory admission was also significantly reduced after referral (6.61 vs 5.70, p=0.02). Overall, 55% @entity1 experienced reduction in admission frequency and hospital days. The impact on admission frequency and hospital days was greatest in those with at least moderate disease (GOLD >= 2, OR 3.2, 95%CI 1.2, 8.9; p=0.019) and those who completed pulmonary rehabilitation (OR 1.7, 95%CI 1.1, 2.8; p=0.04). In contrast, general medical admissions were increased, one third attributable to a cardiovascular cause both before and after referral. CONCLUSIONS: Implementation of @entity1030 multidisciplinary community service was associated with reduced respiratory hospitalisations in the long term. @entity1 with moderate or severe disease, and able to complete pulmonary rehabilitation are much more likely to benefit.
