Resources and Readmission for COPD Exacerbation in Pneumology Units in Spain: The COPD Observatory Project

Objective: To describe resources, performance and care provided in pulmonology units in Spain, assessing their association with 30-day readmission for Chronic obstructive pul-monary disease (COPD) and in-hospital mortality. Methods: This survey was conducted on 116 responsible for the COPD pathway in Pneumology Units/Services from November 2022 to March 2023. Results: Of the 116 participating hospitals, 56% had a pulmonology service and 25.9% had pneumology section. The great majority were public and university hospitals. The number of beds allocated to pulmonology/100,000 inhabitants was 6.6 (3.1-9.2) and pulmonologist staffing was 3.3 (2.6-4.1) per-100,000 inhabitants. In 31.9% of pulmonology unit, there was Intermediate Care Unit dependiente (IMCU) and respiratory team for 24-hour emergency care in 30%, while only 9.5% had interventional pulmonology units. COPD rehabilitation programmes were offered in 58.6% of pulmonology units. The average rate of patients on ventilatory support in acute failure was 13.8 (9.2-25) per-100 discharges, with a 30-day COPD readmission rate of 14.9% with significant differences according to the level of complexity (p=0.041), with a mean length of stay of 8.72 (1.26) days. The overall in-hospital mortality in pulmonology units was 4.10 (1.18) per-100 admissions. In the adjusted model having a discharge support programme and interventions performed during admission (number of patients with ventilatory support) were predictors of a favourable outcome. Hospital stay was also maintained as a predictor of an unfavourable outcome. Conclusions: Knowledge of resources and outcomes in the COPD process will allow appropriate planning to improve the quality of care.