COPD Readmissions

Abstract

Of those patients hospitalized for an exacerbation of COPD, one in five will require rehospitalization within 30 days. Many developed countries are now implementing policies to increase care quality while controlling costs for COPD, known as value-based health care. In the United States, COPD is part of Medicare's Hospital Readmissions Reduction Program (HRRP), which penalizes hospitals for excess 30-day, all-cause readmissions after a hospitalization for an acute exacerbation of COPD, despite minimal evidence to guide hospitals on how to reduce readmissions. This review outlines challenges for improving overall COPD care quality and specifically for the HRRP. These challenges include heterogeneity in the literature for how COPD and readmissions are defined, difficulty finding the target population during hospitalizations, and a lack of literature to guide evidence-based programs for COPD readmissions as defined by the HRRP in the hospital setting. It then identifies risk factors for early readmissions after acute exacerbation of COPD and discusses tested and emerging strategies to reduce these readmissions. Finally, we evaluate the current HRRP and future policy changes and their effect on the goal to deliver value-based COPD care. COPD remains a chronic disease with a high prevalence that has finally garnered the attention of health systems and policy makers, but we still have a long way to go to truly deliver value-based care to patients.

Social and clinical predictors of short- and long-term readmission after a severe exacerbation of copd

“…https://doi.org/10.1371/journal.pone.0229257.t001 Only the patients' dependence to perform BADLs measured by means of a questionnaire not specifically designed for patients with respiratory pathologies and previous history of admissions were identified as predictors over any of the analysed time periods. Thus far, the available references regarding this topic are scarce and heterogeneous, as they were obtained from very diverse studies (from small case series to large databases of insurance companies) and centres forming part of health systems with varying forms of health care services and very disparate patient populations [7,8,10,14,31]. In contrast to the findings of other studies [7,8,10], in our research, the patients' economic income, a low level of education, or poor family support (all determining factors of social and family risk) were not predictors of readmission, although it is true that most of our patients received some sort of economic compensation, had a place to live, and there were practically no cases of serious social isolation.…”

“…This condition is characterized by its chronicity and frequent acute exacerbations that contribute to a significant deterioration of the patients' health, affect the disease's progression and control, and result in a strong demand for health care resources, with the consequent socioeconomic impact, which accounts for 60%-70% of the costs of this disease [1][2][3]. An additional problem associated with this condition is that a significant number of patients admitted to the hospital for an acute exacerbation of chronic obstructive pulmonary disease (AECOPD) will be readmitted in the following weeks or months, as demonstrated in many studies reporting readmission rates of 20%, 35%, and 60% at 30, 90, and 365 days, respectively [3][4][5][6][7][8][9][10]. The detection of factors that may allow us to predict these events has been the subject of multiple research studies carried out in recent years, as this would allow us to stratify the risks more accurately and apply interventions aimed at the most vulnerable groups of patients [3][4][5][6][7][8][9][10][11][12][13].…”

“…Although the available literature is very heterogeneous, the most frequently described predictive variables can be categorized as those related to the patient (previous admissions, severity of the condition, need for oxygen therapy or at-home ventilation, older age, low quality of life, comorbidities, low socioeconomic level, low therapeutic adherence, or active smoking) and those related to the health system (duration of previous hospital admissions, absence of a defined follow-up program, or poor health education) [3][4][5][6][7][8][9][10][11][12][13]. Although some studies have reported that the patients' deficient social situation are predictive factors for readmission and mortality, the analyses carried out to date have been very scarce and solely based on data regarding the patients' level of education, economic income, or the characteristics of the patients' home or caregivers and which have not been collected systematically [14][15][16][17].…”

“…Moreover, most studies have only analysed these factors at 30 or 90 days of hospital discharge, and the long-term evidence is much more limited, with no references on whether these predictive factors vary over time until the patients' readmission [4][5][6][7][8][9][10][11].…”

Reduction in Hospital Readmission Rates Among Medicare Beneficiaries With Chronic Obstructive Pulmonary Disease: A Real-world Outcomes Study of Nebulized Bronchodilators

“…Second, an exacerbation is a risk factor for both an initial hospitalization as well as subsequent readmissions. 10,28,32,33 Because 30-day exacerbation rates were not significantly different between the nebulized ARF and nebulized SABA cohorts, yet allcause and COPD-related 30-day readmission rates were, we assessed our findings against the literature to help inform our interpretation and its implications. Heterogeneity in the intensity of exacerbations (mild vs moderate vs severe) has been found to affect the risk of repeat exacerbations.…”