AN INPATIENT COPD care pathway embedded in the electronic health record improved rehabilitation referrals and home discharges.
Inpatient COPD Care Pathway and Hospital Outcomes
Researchers evaluated an inpatient COPD care pathway introduced across a large academic health system to understand its impact on hospital processes and outcomes for adults admitted with COPD exacerbations. The two-part pathway was integrated into the electronic health record so clinicians could use it for real time decision support, order entry, and documentation during inpatient care.
Over twelve months, 766 patients accounted for 971 COPD hospitalizations. The inpatient COPD care pathway was opened in 14.6% of admissions, and patients whose clinicians used the pathway were demographically similar to those whose clinicians did not. In unadjusted analyses, pathway use was associated with shorter length of stay, averaging 5.4 days compared with 7.1 days without pathway use, and lower standardized hospital costs, with averages of 5,756 USD versus 8,781 USD. Thirty-day readmissions were numerically lower with pathway use, at 16.2% compared with 22.0%, although this difference did not reach statistical significance.
Pulmonary Rehabilitation Referrals and Discharge Patterns
Pulmonary rehabilitation referrals remained low overall, yet pathway use substantially increased the likelihood that patients were referred. Admissions in which the inpatient COPD care pathway was opened were more than five times as likely to include a pulmonary rehabilitation referral compared with admissions without pathway use, with an odds ratio of 5.76 and a 95% confidence interval of 2.47 to 13.4.
Discharge destination also differed. When the pathway was used, 87.3% of patients were discharged home with or without home care services, compared with 74.7% when the pathway was not used. In multivariable models, pathway use nearly doubled the odds of discharge home, with an odds ratio of 1.96 and a 95% confidence interval of 1.14 to 3.39.
Implications for COPD Inpatient Care
Despite relatively low utilization in the first year, embedding an inpatient COPD care pathway in the electronic health record was associated with more consistent referrals to pulmonary rehabilitation and higher rates of discharge home. These findings support the potential of well designed, electronic health record integrated clinical pathways to standardize COPD inpatient care, support multidisciplinary decision making, and align hospital practice with evidence-based management while helping to reduce length of stay and resource use without adversely affecting readmissions.
Reference: Kim N et al. Impact of an inpatient COPD care pathway on hospital care process and outcome metrics. Chronic Obstr Pulm Dis. 2025;12(4):304-316.
