Introduction: A remarkable difference in care delivery pathways for Chronic Obstructive Pulmonary Disease (COPD) is the presence of hospital- at-home for COPD exacerbations in England and its absence in the Netherlands. The objective of this paper is to explain this difference. Methods: Descriptive COPD statistics and care delivery pathways on all care levels within the institutional context, followed by a comparison of care delivery pathways and an explanation of the difference with regard to hospital-at-home. Results: The Netherlands and England show broad similarities in their care delivery pathways for COPD patients. A major difference is the presence of hospital-at-home for COPD exacerbations in England and its absence in the Netherlands. Three possible explanations for this difference are presented: differences in the urgency for alternatives (higher urgency for alternative treatment models in England), the differences in funding (funding in England facilitated the development of hospital-at-home) and the differences in the substitution of tasks to nurses (substitution to nurses has taken place to a larger extent in England). Discussion and Conclusion: The difference between the Netherlands and England regarding hospital-at-home for COPD exacerbations can be explained in three ways. Hospital-at-home has proved to be a safe alternative for hospital care for selected patients, and should be considered as a treatment option for COPD exacerbations in the Netherlands.

Care delivery pathways, Comparative analysis, COPD, Exacerbations, Hospital-at-home, Integrated care
hdl.handle.net/1765/91265
International Journal of Integrated Care
Institute for Medical Technology Assessment (iMTA)

Utens, C.M.A, Maarse, J.A.M, Schayck, O.C.P, Maesen, B.L.P, Rutten-van Mölken, M.P.M.H, & Smeenk, F.W.J.M. (2012). Care delivery pathways for chronic obstructive pulmonary disease in England and the Netherlands: A comparative study. International Journal of Integrated Care, 12(APRIL - JUNE 2012). Retrieved from http://hdl.handle.net/1765/91265