Patient pathway modelling using Discrete Event Simulation to reduce readmissions in COPD

A decision support toolkit (DST) for improving the management and efficiency of chronic obstructive pulmonary disease (COPD) patients is needed to respond to the needs of patients now and in the future. In collaboration with the COPD team of a hospital and community service in London, we conceptualised the pathway for COPD patients and developed a discrete event simulation model. Our model is the first of its kind that integrates readmissions as well as assessing the quantifiable impact of re-designing COPD services. A new intervention, post exacerbation pulmonary rehabilitation (PEPR), helps to reduce the number of readmissions as well as increase patient outcomes, the studies show. However, there is a lack of evidence about its operational and financial impacts. Therefore, we demonstrate that the PEPR policy would be cost-effective and result in 60% increase in the usage of pulmonary rehabilitation. This would provide 6.4% and 15% reductions in occupied bed days and emergency readmissions within 30 days, respectively, with a total increase of 14.87 QALYs. The DST enables key decision makers to better understand the impact of a wide range of scenarios on activity, utilisation of resources, financial implications, and more importantly, it helps commissioners to decide which interventions to implement.