Does the COPD Best Practice Tariff improve patient outcomes?

Abstract

Background: The Best Practice Tariff (BPT) for COPD provides a financial reward when acute exacerbation (AECOPD) admissions in England receive specialist review within 24 hours of admission and a discharge bundle before discharge. Aim: Investigate if AECOPD admissions that conform to the BPT have better outcomes. Methods: An audit of patients admitted to hospital in England and Wales for AECOPD was conducted: 01/02/17-13/09/17. Data were linked with Hospital Episode Statistics and ONS mortality data. The first admission for each patient was included. Conforming to the BPT was defined as a patient receiving respiratory specialist review within 24 hours of admission and a care bundle before discharge. Better patient outcomes of AECOPD were defined as length of stay ≤4 days, no readmission within 30 days of discharge, and alive 30 days after admission. Mixed-effects logistic regression was used to examine the association between conforming to the BPT and AECOPD outcomes (random effect for hospital). Models were adjusted for age, sex, deprivation, admission severity, smoking status, Charlson comorbidity index and mental health issues. Results: 28,345 patients from 181 hospitals were included. 10,530 (37%) admissions conformed to the BPT. Odds ratios for outcomes of AECOPD admissions conforming to the BPT are shown. Conclusion: Conforming to the BPT was not associated with mortality or readmissions, however BPT compliant admissions may be shorter.