Assessment of community care services appropriateness using the chronic obstructive pulmonary disease inpatient admission rate

Background: Assessment of appropriateness is a criterion of increasing relevance for delivering health care services. In Italy, hospital admissions for Chronic Obstructive Pulmonary Disease (COPD) of the elderly is one of the chosen indicators to measure the appropriate use of services. Aim of this study was to assess COPD hospital admission rates as a marker of effectiveness of Community Care services.Methods: Data on hospital admissions for COPD-DRG 88 during the years 2006 and 2011 were collected from hospital discharge records. Correlations among acute inpatient admission rates by Italy's Regions and provision of Long Term Care (LTC) services have been analyzed through univariate and multivariate linear regression models.Results: The national hospitalization rate for COPD decreased from 2006 to 2011 (-35%). The reduction was over 60% for those under the age of 75 and around 14% for those older than 74 years. The COPD inpatient admission rates showed a weak inverse correlation with the provision of LTC, which, however, was statistically significant only for the 65-74 age-group in 2006. The percentage of DRG 88 hospitalization rate variability among the Italian Regions explained by the model increased with the inclusion in the interpretative model of the beds rate and the General Practitioners (GP) rate.Conclusion: The reduction in hospitalizations for COPD in the over-50 is particularly manifest; it seems mainly related to factors other than the availability of outpatient services.