Logo of thoraxThoraxVisit this articleSubmit a manuscriptReceive email alertsContact usBMJ
Thorax. 2003 Nov; 58(11): 947–949.
PMCID: PMC1746518

Evidence for a link between mortality in acute COPD and hospital type and resources


Background: The 1997 BTS/RCP national audit of acute care of chronic obstructive pulmonary disease (COPD) found wide variations in mortality between hospitals which were only partially explained by known audit indicators of outcome. It was hypothesised that some of the unexplained variation may result from differences in hospital type, organisation and resources. This pilot study examined the hypothesis as a factor to be included in a future national audit programme.

Methods: Thirty hospitals in England and Wales were randomly selected by geographical region and hospital type (teaching, large district general hospital (DGH), small DGH). Data on process and outcome of care (death and length of stay) were collected retrospectively at 90 days on all prospectively identified COPD admissions over an 8 week period. Each centre completed a questionnaire relating to organisation and resources available for the care of COPD patients.

Results: Eleven teaching hospitals, nine large DGHs, and 10 small DGHs provided data on 1274 cases. Mortality was high (14%) with wide variation between centres (IQR 9–19%). Small DGHs had a higher mortality (17.5%) than teaching hospitals (11.9%) and large DGHs (11.2%). When corrected for confounding factors, an excess of deaths in small DGHs was still observed (OR 1.56 (CI 1.04 to 2.35)) v teaching hospitals. Analysis of resource and organisational factors suggested higher mortality was associated with fewer doctors (OR 1.5) and with fewer patients being under the care of a specialist physician (OR 1.8). Small DGHs had fewest resources.

Conclusion: Significant differences in mortality may exist between hospital types. The findings justify further study in a proposed national audit.

Full Text

The Full Text of this article is available as a PDF (173K).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Ashton CM, Ferguson JA, Goldacre MJ. In-patient workload in medical specialties: 2. Profiles of individual diagnoses from linked statistics. QJM. 1995 Sep;88(9):661–672. [PubMed]
  • Antó JM, Vermeire P, Vestbo J, Sunyer J. Epidemiology of chronic obstructive pulmonary disease. Eur Respir J. 2001 May;17(5):982–994. [PubMed]
  • Roberts CM, Lowe D, Bucknall CE, Ryland I, Kelly Y, Pearson MG. Clinical audit indicators of outcome following admission to hospital with acute exacerbation of chronic obstructive pulmonary disease. Thorax. 2002 Feb;57(2):137–141. [PMC free article] [PubMed]
  • Roberts CM, Ryland I, Lowe D, Kelly Y, Bucknall CE, Pearson MG. Audit of acute admissions of COPD: standards of care and management in the hospital setting. Eur Respir J. 2001 Mar;17(3):343–349. [PubMed]
  • Almagro Pedro, Calbo Esther, Ochoa de Echagüen Anna, Barreiro Bienvenido, Quintana Salvador, Heredia José L, Garau Javier. Mortality after hospitalization for COPD. Chest. 2002 May;121(5):1441–1448. [PubMed]
  • Chaudhry R, Goel V, Sawka C. Breast cancer survival by teaching status of the initial treating hospital. CMAJ. 2001 Jan 23;164(2):183–188. [PMC free article] [PubMed]
  • Khuri SF, Najjar SF, Daley J, Krasnicka B, Hossain M, Henderson WG, Aust JB, Bass B, Bishop MJ, Demakis J, et al. Comparison of surgical outcomes between teaching and nonteaching hospitals in the Department of Veterans Affairs. Ann Surg. 2001 Sep;234(3):370–383. [PMC free article] [PubMed]
  • Polanczyk Carsi A, Lane Anthereca, Coburn Michelle, Philbin Edward F, Dec G William, DiSalvo Thomas G. Hospital outcomes in major teaching, minor teaching, and nonteaching hospitals in New York state. Am J Med. 2002 Mar;112(4):255–261. [PubMed]
  • Jarman B, Gault S, Alves B, Hider A, Dolan S, Cook A, Hurwitz B, Iezzoni LI. Explaining differences in English hospital death rates using routinely collected data. BMJ. 1999 Jun 5;318(7197):1515–1520. [PMC free article] [PubMed]
  • Donabedian A. Evaluating the quality of medical care. Milbank Mem Fund Q. 1966 Jul;44(3 Suppl):166–206. [PubMed]
  • Rudd AG, Irwin P, Rutledge Z, Lowe D, Wade DT, Pearson M. Regional variations in stroke care in England, Wales and Northern Ireland: results from the National Sentinel Audit of Stroke. Royal College of Physicians Intercollegiate Stroke Working Party. Clin Rehabil. 2001 Oct;15(5):562–572. [PubMed]

Articles from Thorax are provided here courtesy of BMJ Group


Save items

Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...


  • MedGen
    Related information in MedGen
  • PubMed
    PubMed citations for these articles

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...