Early discharge with follow-up support in COPD Table 1 Knowledge of COPD assessment. List of topics related to COPD discussed with each patient at their 6 week follow up visit. Patients who demonstrated an understanding of all topics on the list were included for self management education Topics Comment Topics Comments Dirty sputum Inhalers Increased cough Nebulizers Increased SOB Smoking Cessation Increased wheeze Role of exercise Chest tightness Relaxation Decrease in ADL Vaccines Antibiotics Avoidance measures Steroids Emergency Patient understands all topics Yes No Abbreviations: ADL, activities of daily living; COPD, chronic obstructive pulmonary disease; SOB, shortness of breath. steroids, bronchodilators, expectorants and nebules. In particular, a written personalized action plan was provided that gave speciﬁc instructions as to how to recognize an exacerbation and self-administer medication. In addition a sputum jar was provided and sputum clearance techniques explained. In each case an explanatory letter was sent to the patient’s GP and telephone support provided Monday to Friday during ofﬁce hours. Outcome measurements In the same cohort of patients the number of emergency department presentations and hospital admissions in the 6 month and 1 year period immediately after, compared to immediately prior to inclusion in the respiratory outreach programme was compared. Data analysis Statistical analysis was performed using SPSS version 10.0 (SPSS Inc., Chicago, IL, USA). Medians and interquartile ranges (IQRs) were used as the data were nonnormal. Comparisons between admissions rates were made using Wilcoxon sign-ranked test for paired data. Ninety-five percent conﬁdence intervals (CIs) for the differences in rates before and after inclusion in the programme at 6 and 12 months were calculated based on Poisson assumptions. These 95% CIs that are not overlapping indicate statistical signiﬁcance at the 5% level. Comparison of the absolute change in admissions between the 60 self management patient subgroup and the remaining 186 patients included in the respiratory outreach programme was performed using the Wilcoxon rank sum test. Results Twelve hundred and forty-one patients were referred to the early discharge programme of whom 246 were accepted. The mean (standard deviation) length of stay was 1.48 (1.7) days and there were 2.4 (1.12) home visits required per patient. Patient characteristics for the group as a whole and the subgroup who went on to receive formal self-management education are outlined in Table 2. Table 2 Clinical characteristics of patients included in the early discharge programme and the subset that received self-management education. There were no signiﬁcant differences between the two groups.Values are shown as mean ± SD Early discharge programme Self-management education N 246 60 Age 67 ± 9 69 ± 9 FEV1% 50.7 ± 20.8 50 ± 21.6 FEV1/FVC 53.2 ± 13.8 50.1 ± 13.6 TLCO% 52.0 ± 18.7 53.8 ± 19.3 Abbreviations: FEV1, forced expiratory volume in one second; FVC, forced vital capacity; TLCO, functional test for measuring the diffusing capacity of the lungs for carbon monoxide. International Journal of COPD 2009:4 57