Having the right intelligence can help to speed up care integration, offering benefits to patients and health services, write Meghan Robb and colleagues

Chronic obstructive pulmonary disease (COPD) is increasingly prevalent in the UK, with hospitalisation due to its acute exacerbations (AECOPD) putting a significant economic burden on health services. Today, one in eight emergency admissions in the UK is due to AECOPD, and COPD accounts for the second-highest number of total bed days.

Projecting the impact of care pathway redesign and achieving it are two very different animals

At present, COPD care is primarily reactive, focusing on treating AECOPD rather than preempting problems.

Redesigning COPD care pathways could prevent most AECOPD episodes currently burdening the system’s inpatient care setting, and also help the service manage the increasing demand for COPD care in the future. To improve clinical quality and patient satisfaction while stabilising the health economy, care delivery needs to move from current reactive models to proactive management.

Improve quality while saving

It is well documented that holistic COPD management programmes help identify patients early, reducing secondary care admissions and length of stay (LOS), and improving the patient’s experience of care and overall care quality. Now, advanced forecasting models are able to quantify the effects of a proactive approach to COPD care pathway management - projecting a reduction in COPD inpatient activity by 46 per cent over the next 10 years.  Considering savings related to the inpatient COPD arena alone, this equates to national savings of more than £800m.

The same models show nearly universal opportunity across all of England. Projections reveal all PCTs have the opportunity to save between 32 per cent and 46 per cent of current inpatient COPD spend by 2014.

Accomplishing care pathway redesign

Projecting the impact of care pathway redesign and achieving it are two very different animals - and though data analyses abound these days, concise and actionable strategies to achieve real change remain elusive in many cases. In the case of COPD care, orchestrating the collaboration of multiple partners, coordinating information flow and patient activity across sites of care and engaging patients as active partners within the care pathway remains complex work.

As these types of care model innovations remain paramount, regardless of the commissioning body empowered to drive change, those tasked with managing this change can use advanced analytics and global intelligence to ensure success and speed up results.

We set out the following six improvement steps as a guide for COPD care pathway management, and as a template for achieving the opportunity at hand.

  • First, find out how much your organisation could save by reducing COPD inpatient activity while improving quality and patient experience. Use COPD forecast data accompanying this article to calculate PCT and SHA specific opportunity, and to generate savings scenarios for planning purposes.
  • Second, build a case for change that will motivate the organisation and necessary partners across the care continuum. Use the care use forecasts provided for all of England to put COPD savings in the context of the national health economy. Consider the economic impact that savings on just two HRGs can have when charting the local health economy’s near-term course for QIPP targets. Review the provided case studies and use these documented success stories to build momentum for change. There is a wide array of available resources to inspire, engage and secure the commitment of all parties involved in the COPD care pathway.
  • Next, plan an action strategy, including whom to involve, what steps to take, timelines for success and likely impact. An Improvement Guide for COPD management accompanies this article, and is presented as a detailed template for how to undertake implementation of a multidimensional, community-based disease management strategy for COPD. Details on the rationale behind each component of a comprehensive COPD change initiative (ie, improvements to patient education, increasing access to healthcare advice, or using technology for better patient and carer connectivity) as well as the in-depth action steps needed for success at each component stage are also provided.
  • Keep in mind, to gain maximum impact from a COPD disease management programme, multiple improvement options should be included across a pathway redesign initiative, though the emphasis given to each can vary depending on local requirements and facilities.  This multidimensional approach necessitates complex change management. Ongoing change management can be aided by understanding target metrics with which to mark progress. Target metrics meant to reinforce a societal, local economy and national economy case for change in COPD management have been provided in the accompanying data sets. Communication of target metrics and progress to date among all parties involved in the programme development and implementation is critical for success.
  • Learning from others creates a strong foundation for sound decision making. Consider the operational insights, management strategies, and global lessons learned provided in the accompanying Global Practice Summary and Case Study documents, applying those which resonate to local COPD care pathway redesign initiatives. This intelligence can help those charged with complex change management to understand the application of COPD pathway redesign concepts within the NHS and across other international health economies.
  • Finally, plan ahead for ongoing programme audits as a means to demonstrate value to patients and the health service, and to successfully sustain a COPD programme. Planned programme audits should include metrics tracked across multiple facets of the revised care pathway, including but not limited to, patient register expansion, COPD patient attendances at A&E, LOS reductions, hospital admission reductions, per patient annual number of days spent in a hospital bed, and total PCT savings. A well thought-through and appropriately implemented multidimensional community-based COPD management programme should lead to a reduction in all of these metrics.

These six implementation steps, together with the additional data and resources provided, create an action-oriented guide for proactive change to COPD care. Addressing this one disease presents a route to improved quality and care efficiencies amid a challenging healthcare environment.

Top tips

  •  Ensure all clinical stakeholders are fully informed throughout the scoping and implementation process to establish buy-in at an early stage.
  • Form an implementation board with all relevant stakeholder groups.
  • Define and monitor clinically relevant performance and outcome indicators to ensure effective implementation and operation.
  • Provide ongoing, detailed but concise, service information to all parties involved along the care pathway, including patients, in order to reinforce commitment, strengthen engagement and accelerate change.

About Change Forecast

Change Forecast is an online resource delivering in-depth analysis on future opportunities for improvement and cost savings in the health service.

This quarterly feature, developed with Sg2, provides detailed insight on what the future looks like for each organisation for a specific disease area, along with best practice case studies and guidance on how to capitalise on the opportunity.

Unlike traditional population-based estimates, this forecast examines the cumulative effects and interdependencies of population, economics, emerging care pathways, epidemiology, innovation and technology, and other key factors driving change in the use of healthcare services.

Use the Change Forecast to help you identify the opportunity, plan a strategy and manage the change.

If you would like more information on the data from Sg2, call 020 7399 4455 or email Yashu at yreddy@sg2.com

COPD care: how to save millions