Title: An evaluation of the effectiveness of care bundles as a means of improving hospital care and reducing hospital re-admission for patients with chronic obstructive pulmonary disease (COPD)
Funder: Department of Health (England)

Abstract: This research seeks to evaluate the effectiveness of care bundles as a means of improving hospital care and reducing re-admission for patients with chronic obstructive pulmonary disease (COPD). It is designed as a controlled before-and-after study with nested qualitative case-studies. The population of interest is that group of people admitted to hospital with an acute exacerbation of COPD as their primary condition. The intervention considers the effect of delivering COPD care bundles at both the point of admission and discharge - where a care bundle is defined as a number of components of care grouped and pro-actively managed into clinical pathways. The study will compare 20 NHS trusts who deliver the COPD care bundle intervention and a matched control group of 20 NHS trusts who deliver usual care during the study period. From this initial set of 40 participating sites a stratified random sample of 8 intervention trusts will be recruited with 8 controls for in-depth quantitative study. A purposeful sample of both intervention and control trusts will also be examined as case-studies using a range of qualitative methods. Quantiative data will be collected on admissions for COPD during a 12-month period before and after implementation of care bundles ensuring that data are collected during the same ‘before’ and ‘after’ period for matched intervention and control sites.A range of outcomes will be measured including:- COPD re-admission rates at 28 days (primary outcome)- total number of COPD admissions - in-hospital mortality for patients admitted with COPD- length of stay for patients with COPD- total bed days for COPD admission- COPD re-admission rates at 90 days- mortality at 90 days for patients admitted with COPD- total number of patients in whom COPD care bundle is used- compliance with COPD care bundles- time taken to deliver COPD care bundles- costs of in-patient medications and procedures- patient and carer experience in relation to COPD care.Additionally the context and process of care for patients receiving COPD care bundles will be qualitatively assessed and compared with usual care across both hospital and community settings.Analysis of the quantitative data will involve use of appropriate regression models including a group*time interaction term where necessary to estimate the difference in change in outcome between intervention and control sites before and after introduction of the COPD care bundle intervention. Qualitative data from multiple sources will be analysed using a range of techniques in order to elucidate and explain the internal processes and the interaction between staff and patients that affect the delivery of COPD care at the point of admission and pre / post discharge. Economic analysis will consider the impact of any change in re-admission rates and length of stay in relation to change in total cost before and after the implementation of COPD care bundles. Cost-effectiveness of the COPD care bundles and the probabilistic uncertainty associated with their provision will be described using cost-effectiveness acceptability curves based on bootstrapped re-sampling of the observed cost and outcomes data. Sensitivity analyses will be performed where appropriate. This research will provide independent evidence of the impact of COPD care bundles on hospital admissions and re-admissions. It will also indicate how a co-ordinated package of care might improve quality of care patient / carer experience equity of access and service delivery for patients with COPD taking into account cost implications and implementation challenges. The research will also inform the development and delivery of care bundles for other health conditions.


Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: RESPIRATORY