Presentation (CTI)

OBJECTIVES: Ambulatory care sensitive conditions (ACSCs) are the conditions for which hospitalization could be prevented by timely and effective ambulatory care, so ACSC admissions can be considered as an indicator of the quality of ambulatory care services. This study aimed to examine use of a multidisciplinary COPD management service was associated with a lower level of ACSC admissions among COPD patients.
METHODS: A retrospective cohort study was conducted. The local list of ACSC (including COPD) was generated from a previous Delphi study. The anonymized electronic health records were obtained from the public healthcare system. Patients with COPD who used public outpatient services during 2010-2014 were selected. Those who used the nurse and allied health clinics (NAHC) for respiratory care, were assigned to the exposure group and those who did not use NAHC were assigned to the reference group. Propensity score matching was used to select comparable individuals from the two groups. Quasi-Poisson regression and Log-link gamma regression were applied to examine the association between the use of NAHC and the outcomes of ACSC admissions during a 5-year follow-up period.
RESULTS: The results showed that the use of NAHC was associated with a lower frequency of ACSC admissions (incidence rate ratio [IRR]: 0.74 (0.69-0.81)) and a shorter length of stay of ACSC admissions (IRR: 0.37 (0.25-0.56)). It was also associated with a lower frequency of ACSC admissions via the emergency room (IRR: 0.78 (0.72-0.84)) and a shorter length of stay of these admissions (IRR: 0.28 (0.17-0.45)). The associations between the use of NAHC and admissions due to ACSCs other than COPD were found stronger than the associations with admissions due to COPD alone.
CONCLUSIONS: The findings showed that this COPD management service was associated with lower ACSC admission, implying its potential to reduce avoidable hospitalizations and hospital care resource consumption.