Outcome of Service Development Programme on Within-28-Days Readmissions of Chronic Obstructive Pulmonary Diseases (COPD) Patients: a Case Study of Somdejphrajaotaksinmaharaj Hospital, Tak Province - ผลการพัฒนาระบบการดูแลผู้ป่วยโรคปอดอุดกันเรื้อรังต่อการรับผู้ป่ วยในซ้ำใน 28 วัน: กรณีศึกษา โรงพยาบาลสมเด็จพระเจ้าตากสินมหาราช จังหวัดตาก

บทคัดย่อ

              Chronic obstructive pulmonary diseases (COPD) has been a huge public health problem in Thailand for ages. It is also one of the five most common diseases of inpatients in the Internal Medicine Department of Somdejphrajaotaksinmaharaj Hospital, Tak province. In this regard, the hospital has developed a service development programme emphasizing on multi-disciplinary team approach in improving service for, and helping shape behavior of COPD patients. The objective of this study was to explore the outcomes of the programme by utilyzing within-28-days readmission as the key indicator. A total of 36,360 patient records were collected between October 2009 and June 2015. The data were analyzed by descriptive statistics in terms of mean and frequency; and inferential statistics, in which interrupted time series analysis (Prais-Winsten regression) and multiple logistic regression with marginal effects were applied. It was found that readmission ratio of COPD inpatients was approximately 24.0%, which was larger than that of all inpatients (13.0%). The programme had reduced COPD readmissions by 10 cases per quarter. At individual level, the programme reduced readmission probability of COPD patients by 2.6%. Furthermore, the programme effect was more apparent in COPD patients who had admission history at least twice with a 8.4% decrease in the readmission rate. Yet, this study still experienced some limitations,such as the incompleteness of data, and short data collection period. The programme should be improved by emphasizing more on screening for non-communicable disease risk factors; and should be expanded to cover lower-level health facilities.

Key words: chronic obstructive pulmonary diseases, readmission, inpatient, interrupted time series, multiple logistic regression