Impact of an Inpatient COPD Care Pathway on Hospital Care Process and Outcome Metrics.

Abstract

Background: Variable hospital care for COPD and underutilization of pulmonary rehabilitation (PR) may contribute to poor outcomes. Clinical pathways can optimize care by providing real-time decision support based on evidence and expert consensus. An inpatient COPD pathway was implemented in May 2021.

Research question: To evaluate the impact of the COPD pathway on LOS, discharge disposition, resource use, PR referrals and readmissions.

Study design and methods: A two-partCOPD pathway embedded into the electronic health record was built by multidisciplinary providers across a large academic medical center. Providers could place orders and document notes directly from the pathway. We identified all COPD hospitalizations one year after pathway implementation using International Classification of Disease, Tenth Revision, Clinical Modification (ICD-10-CM) codes according to methods used by the Centers for Medicare & Medicaid Services.

Results: 766 patients contributed 971 hospitalizations. The pathway was opened in 142 (14.6%) hospitalizations. No significant differences in demographics, insurance or smoking status were noted between pathway versus non-pathway patients. Bivariate analyses demonstrated lower LOS (5.4 days v. 7.1 days, p=0.001) and total costs ($5,756 v. $8,781, p< 0.001) with pathway use, but no significant difference between 30-day readmissions (16% v 22%, p=0.12). In multivariable analysis, pathway use was associated with greater PR referrals (OR 5.76 95% CI 2.47-13.45, p<0.001) and discharges to home (OR 1.96 95% CI 1.13-3.39, p=0.016).

Interpretation: Despite low utilization, pathway use was associated with more PR referrals and discharges to home with a trend toward lower LOS, resource use, and decreased readmissions.