COPD Overdiagnosis and Its Effect on 30-Day Hospital Readmission Rates

Rice, Richard; Xiao, Han; Al-Jaghbeer, Mohammed

doi:10.4187/respcare.07536

Cited by 6 publications

(11 citation statements)

References 24 publications

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“…The possibility of misdiagnosis cannot be completely excluded because COPD is confirmed only by medical diagnosis. 43 Additionally, we did not include an objective index to assess the severity of the disease at the time of index admission. Because COPD severity is unknown, this can also affect the overall conclusion.…”

Section: Discussionmentioning

confidence: 99%

The Association with COPD Readmission Rate and Access to Medical Institutions in Elderly Patients

Kim¹,

Choi²,

Kim³

et al. 2021

COPD

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Purpose Up to 20% of patients with chronic obstructive pulmonary disease (COPD) require re-admission within 30 days of discharge after hospitalization for acute exacerbations of the disease. These re-admissions can increase morbidity and the economic burden of COPD. Reducing re-admissions has become a policy target in many developed countries. We investigated the risk factors for COPD re-admissions among older adults with COPD. Patients and Methods Data obtained from the National Health Insurance Service-Senior Cohort (NHIS-SC) in Korea were analyzed. The subjects included 558,147 patients aged ≥70 who had been admitted for COPD between 2013 and 2015. Re-admission was defined as being re-hospitalized within 30 days after discharge. The key variables selected from the database included income-based insurance contributions, demographical variables, information on inpatient medical services, types of healthcare facilities, and emergency time relevance index (TRI). The TRI is a regional medical-use analysis index that evaluates whether the capacity of the medical services available is appropriate for the medical needs of the target residents. Results In 814 COPD re-admission cases among 4867 total admissions due to COPD in elderly subjects, higher re-admission rates were associated with male sex, admission to district hospitals, medical aid recipients, and a longer hospital stay. When additionally adjusting the TRI to identify the difference in re-admission rates due to medical service accessibility, the same results were found, except for the areas of residence. The TRI was lower in re-admission cases (odds ratio 0.991 [95% CI, 0.984‒0.998], P = 0.013). Conclusion In this study, COPD re-admission rates among older adults were significantly associated with sex, length of hospital stay, and the type of hospital. The capacity of the medical services provided was also related to the COPD re-admission rate. Better access to appropriate emergency services is associated with reduction of COPD re-admission rates.

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Section: Discussionmentioning

confidence: 99%

The Association with COPD Readmission Rate and Access to Medical Institutions in Elderly Patients

Kim¹,

Choi²,

Kim³

et al. 2021

COPD

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“…Therefore, hospital managers can use the model to recognize the conditions where more improvement is needed, which is an advancement upon other recent literature focusing on treatment plans of a single health condition [37]. Some studies have also investigated only one of the six health conditions for hospital readmissions [27,50]. The SM model provides an opportunity to efficiently allocate resources to health conditions with higher readmission probabilities than the mean peer group to reduce the risk of readmission.…”

Section: Discussionmentioning

confidence: 99%

Care Strategies for Reducing Hospital Readmissions Using Stochastic Programming

Lahijanian

Alvarado

2021

Healthcare

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A hospital readmission occurs when a patient has an unplanned admission to a hospital within a specific time period of discharge from an earlier or initial hospital stay. Preventable readmissions have turned into a critical challenge for the healthcare system globally, and hospitals seek care strategies that reduce the readmission burden. Some countries have developed hospital readmission reduction policies, and in some cases, these policies impose financial penalties for hospitals with high readmission rates. Decision models are needed to help hospitals identify care strategies that avoid financial penalties, yet maintain balance among quality of care, the cost of care, and the hospital’s readmission reduction goals. We develop a multi-condition care strategy model to help hospitals prioritize treatment plans and allocate resources. The stochastic programming model has probabilistic constraints to control the expected readmission probability for a set of patients. The model determines which care strategies will be the most cost-effective and the extent to which resources should be allocated to those initiatives to reach the desired readmission reduction targets and maintain high quality of care. A sensitivity analysis was conducted to explore the value of the model for low- and high-performing hospitals and multiple health conditions. Model outputs are valuable to hospitals as they examine the expected cost of hitting its target and the expected improvement to its readmission rates.

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“…Numerous studies have shown that using teach-back education can reduce 30-day readmission rates. 3,7,8 Hospital readmissions are an important quality indicator for hospitals across the US; decreasing the rate of readmissions can result in an enormous cost-saving for a relatively inexpensive intervention. Most important, when quality care is provided, patient outcomes improve, and patient safety increases.…”

Section: Repeated Learningmentioning

confidence: 99%