Il Governo Clinico della BPCO a Brescia: focus sulla Riabilitazione

Introduction. Pulmonary rehabilitation has assumed a prominent place in the systems of regional and local clinical governance. The aim of the work is to present flows and volumes of COPD patients admitted, during the year 2010, to 6 Rehabilitation Units in the territory of ASL of Brescia. Materials and methods. Using DRG 88 and 87 related administrative and clinical data base, the following data were collected and elaborated: n. of patients, provenience, comorbidity, dependency index, clinical risk index, performed procedures, stay, educational courses and continuity of care programmes, post-discharge outcomes. Results. Over one year 1,355 patients (0.11% of the ASL Brescia population and 2.3% of the estimated COPD) had access to a path of rehabilitation. Preponderance was for males (56%) with 75 ± 4 years old and with more than 3 comorbidities. Patients were all in GOLD gravity Classes III and IV of and come mostly from home (59%). The range of services in the DH was 27%. The average stay was 29 ± 11 days. 13% of the patients were treated with non-invasive and 6% with invasive mechanical ventilation. The most commonly used scales were: CIRS, Barthel, BODE and MORSE. 88 DRG was used in 54%, 87 DRG in 20% of admissions. Almost all patients followed an educational programme and 49 patients were included in a path of protected discharge. Most patients were discharged at home while 5% required an acute care hospitalization; mortality was 1.9%. Conclusions. In the territory of ASL of Brescia: 1) a small sample of COPD patients have access to rehabilitation; 2) these are generally patients with a serious impairment of lung function and important comorbidity; 3) they come mainly from home; 4) they often use non-inpatient setting; 5) in the face of efforts for common educational paths and continuity of care, there are important organizational and performance differences among centers.