An evaluation of ‘care bundles’ as a means of improving hospital care for patients with COPD: results of a multi-centre study in the UK

Aim: Care bundles are sets of evidence-based interventions, elements of which are known to optimise clinical outcomes. We evaluated their effectiveness in improving outcomes of hospital care for patients with COPD. Method: A mixed-methods, controlled before-&-after study design was used to examine COPD care bundle implementation in England & Wales. Patient-level data were collected over 12 months before & after introduction of bundles at 7 acute hospitals using bundles (IMP) & 7 comparator hospitals (COMP). 140 sets of randomly sampled case notes were studied to assess outcomes of care at each site. Results: There were 19,097 unplanned admissions during the full study period (9881 at COMP sites; 9216 at IMP sites). 27.3% of patients in IMP sites received all five elements of the discharge care bundle vs 0.8% in COMP sites. Our primary outcome was 28-day readmission for COPD. We found no evidence that change over time differed between IMP & COMP sites (OR 1.05; 95%CI: 0.84-1.31). In addition, no difference was observed for in-hospital mortality, length of stay or 90-day readmission. ER attendance following discharge was reduced in IMP sites (OR 0.55, 95%CI: 0.47-0.63 p<0.001). Qualitative data suggested that health professionals value bundles as a means of focusing on best care but lack skills in process redesign. Conclusion: Care bundles improve process reliability but had a limited impact on outcomes. They are complex to implement. Clinicians need training & support to change clinical pathways. Study Funding: National Institute for Health Research (NIHR) Health Services & Delivery Research (HS&DR) Programme - project number 12/130/53