The Analyses of Individual Patient Pathways : Investigating Regional Variation in COPD readmissions

Regional variation for those treated for chronic obstructive pulmonary disease (COPD) has been studied amongst many public health issues. However, for those experiencing frequent readmissions were not considered. The objective is to determine the probability of a patient being in the high risk group in their next readmission, given patient and regional specific previous readmissions, i.e. capturing individual clinical pathways of patient's leading to multiple readmissions. Data on COPD patients were extracted from the national (England) hospital episodes statistics (HES) dataset. Individual patient pathways from initial admission through to more than four readmissions are captured. Here, patients are classified into the low risk of readmission group (LRRG) and the high risk of readmission group (HRRG). This classification is based on the definition of readmission, where we have previously developed a stochastic modelling approach to determine the appropriate width of a time window in defining readmission. Hence, using this classification as a response variable, a marginal continuation-ratio logit model is used to examine regional disparities in progressing through multiple readmissions. Significant regional differences were found in each readmission and classification groups (HRRG or LRRG). For example, COPD patients from the North West of England were found to be 16% more likely to experience multiple readmissions than Yorkshire and The Humber region.