{
  "abstract": "Introduction and Objectives The INTEGR-COPD study demonstrated adherence to COPD management guidelines can be improved through the integration of respiratory specialists into general practice to deliver annual COPD reviews. 1 Unexpectedly, the study found a statistically significant increase in hospitalisations among the intervention group (IRR 1.86, 95% CI 1.38 to 2.52; p<0.001) contrary to findings from a previous systematic review.2 This secondary analysis aims to explore the potential reasons for this finding.Methods All patients with ‘COPD-related Hospitalisation’ during the 12 month follow-up period were identified from the original intention-to-treat dataset. Secondary care electronic patient records from the primary hospital site in the locality were reviewed to detail each admission episode. One record was removed due to missing data limiting further analysis. Statistical analysis was performed using zero-inflated poisson regression using STATA v19.5 (STATACorp).Results In the intervention group, 91/180 (51%) original listed admission episodes were identified retrospectively, compared to 157/167 (94%) in the control group. Although there is a small possibility that patients may have been admitted to other hospitals either regionally or nationally, geographical mapping shows that the secondary care system utilised represented the closest hospital trust. New analysis now shows an IRR of 0.74, 95% CI 0.55 to 1.01, p=0.055, adjusting for age, sex, baseline hospitalisation and clustering.Conclusions Our findings now show that integrated COPD care is likely to have reduced hospitalisation episodes rather than increased them as initially reported. These results are likely to reflect methodological differences in the original study such that the intervention group recorded patient reported outcomes whilst the control group used hospital records to overcome missing data. This highlights the importance of triangulating patient reported data with electronic records to ensure reliability and the importance of consistent methodology across study arms.References Patel K, Pye A, Edgar RG, Beadle H, Ellis PR, Sitch A, et al. Cluster randomised controlled trial of specialist-led integrated COPD care (INTEGR COPD). Thorax 2024;79(3):209.Poot CC, Meijer E, Kruis AL, Smidt N, Chavannes NH, Honkoop PJ. Integrated disease management interventions for patients with chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews 2021;(9):CD009437. DOI:10.1002/14651858.CD009437.pub3.",
  "authors": [
    {
      "affiliations": [
        "University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK"
      ],
      "name": "K Varma"
    },
    {
      "affiliations": [
        "Department of Applied Health Sciences, University of Birmingham, Birmingham, UK"
      ],
      "name": "LA Boast"
    },
    {
      "affiliations": [
        "Department of Respiratory Medicine, St Bartholomew’s Hospital, Barts Health NHS Trust, London, UK"
      ],
      "name": "K Patel"
    },
    {
      "affiliations": [
        "Department of Applied Health Sciences, University of Birmingham, Birmingham, UK"
      ],
      "name": "AM Turner"
    }
  ],
  "title": "P15 Understanding increased hospitalisations in INTEGR-COPD: a secondary analysis of admission data",
  "uid": "b64d6a5e-dffc-5d4c-8078-8431c88ab1f0"
}