A prospective cohort study of the effectiveness of clinical pathways for the in-patient management of acute exacerbation of chronic obstructive pulmonary disease (COPD)

Abstract

The aim of this study was to compare the clinical and functional outcomes of patients with an acute exacerbation of chronic obstructive pulmonary disease (COPD) treated with standard care to those treated with a clinical pathway at a regional Victorian university teaching hospital. An eighteen-month prospective cohort study was conducted comprising 178 patients admitted via the emergency department with a primary diagnosis of acute exacerbation of COPD. Of these, 90 were treated with standard care and 88 using a coordinated multidisciplinary clinical pathway. Clinical outcome measures included: oxygen saturation, subjective dyspnoea and anxiety levels, length of stay, complication rates and readmission within 28 days. Results indicated that there was no significant difference between the groups on length of stay, clinical and functional outcome apart from significantly reduced anxiety levels in the pathway group. Pathway patients had a 0.89-day (13.2%) shorter length of stay than standard care patients did and numerically less complications and readmissions. We conclude that patients cared for under a clinical pathway for COPD in this study did not experience worse clinical outcomes compared to those receiving standard care.