Abstract:
Objectives: To identify the differential effects of
patient, health service, temporal and geographic factors
on length of stay (LOS) for chronic obstructive
pulmonary disease (COPD)-related admissions.
Design: We used stratified Cox proportional hazard
model to evaluate the association between LOS and
patient, health service, temporal and geographical factors.
Setting: Patients resident in Blackpool, North West
England, admitted to the local hospital with COPD.
Participants: We used the Admitted Patient Care General
Episode Commissioning Dataset for the period 1 April
2005–31 March 2010. We analysed records of admission
spells among patients resident in Blackpool aged 40 years
or older admitted with a primary diagnosis of COPD.
Results: There were 2410 admissions meeting the
inclusion criteria over the period. These admissions were
attributed to 1172 COPD patients, an average of 2.06
admissions per patient. The median LOS was 6 days
(95% CI 6 to 6) while the mean was 9.8 days (95% CI 9.1
to 10.5). Patients were 22% more likely to be discharged
earlier in 2009/2010 compared with 2005/2006 (adjusted
HR 1.22; p=0.0100). LOS was associated with
socioeconomic deprivation with those in the most
deprived areas being 35% less likely to be discharged
earlier compared with those from the least deprived areas
(adjusted HR 0.65; p=0.0010).
Conclusions: LOS among COPD patients have reduced
over the period of the study. Age, deprivation, Charlson
index, specialty of admission and cause of exacerbations
were independently associated with LOS. Though there
were no significant associations between LOS and season
of admission and distance from hospital, there were
significant variations in LOS associated with these
variables based on selected patient characteristics.
