Novel Integrated Health and Social Care Data Enabling Earlier Detection of COPD and Intervention Delivery Through Optimised Care Pathways

COPD is a progressive condition with loss of lung function occurring at a faster rate early in the disease trajectory, with major consequences in an ageing population, including cardiovascular risk, respiratory failure, and lung cancer. It is prevalent as one among multiple long-term conditions (MLTC), contributes to health disparities, and is the third leading cause of death worldwide, with mortality rates in the UK continuing to be one of the highest in the EU. Early diagnosis, alongside timely and effective interventions addressing unmet health and social care (HSC) needs, are critical for quality of life and wellbeing. Social care services and interventions are of particular importance for those living with COPD because their provision enable more effective self-care and fewer incidences requiring health care resources. However, social care continues to be undervalued and underfunded compared to healthcare. One major barrier is the lack of data-driven insight into how health and social care systems work together for people living with COPD. This project aims to close this gap by linking newly available social care datasets with existing healthcare and third-sector datasets so that we can begin to understand how well (or otherwise) the system operates as a whole for people living with COPD, and what the implications are for optimising bundles and pathways of care for people living with COPD. The proposed project will improve health and social care outcomes for individuals living with COPD by leveraging novel, integrated health, social care and third sector data, creating innovative data dashboards and novel predictive analytics. These elements will inform a co-designed theory of change, facilitating earlier detection and more effective intervention through newly optimised care pathways. Additionally, this initiative involves early testing and iterative improvement of those novel care pathways in order to optimise service delivery within a regional health and social care partnership testbed.