Reducing Chronic Obstructive Pulmonary Disease Hospital Readmissions. An Official American Thoracic Society Workshop Report

Press, Valerie G.; Au, David H.; Bourbeau, Jean; Dransfield, Mark T.; Gershon, Andrea S.; Krishnan, Jerry A.; Mularski, Richard A.; Sciurba, Frank C.; Sullivan, Jamie; Feemster, Laura C.

doi:10.1513/annalsats.201811-755ws

Cited by 68 publications

(67 citation statements)

References 52 publications

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“…Moreover, coordinated work with the social services should be implemented to improve the impact of the patients' dependence to perform BADLs so as to reduce the rate of readmissions based on the findings obtained in this respect for other pathologies [27]. This result could also reinforce the role of Pulmonary Rehabilitation in reducing short-and longterm readmission following discharge from an index admission due to a severe COPD [18]. The use of a non-specific index of respiratory pathology in this study, such as Barthel's index [21], which is influenced not only by dyspnoea, but also by other functional mobility or cognitive impairments, or even by the patients' specific degree of support, could have influenced the strength that this variable had in our study.…”

Section: Discussionmentioning

confidence: 90%

“…Experts in this field state that these variables must be included in the predictive scales [17]. In fact, the current US program that financially penalizes hospitals with a great number of readmissions has been criticized due to the fact that it does not make any adjustments for social aspects [18,19]. Thus, it seems surprising that little emphasis has been placed on social dysfunction (financial situation, housing situation, family support, caregiver overload, ability to perform basic and instrumental activities, and risk of social exclusion), as the benefit that can be obtained by improving these variables would have a greater impact on the patient than small improvements achieved in their overall situation and pulmonary function [14][15][16][17].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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Introduction and objectives The aim of this study was to evaluate the predictive ability of multiple social, and clinical factors for readmission after a severe acute exacerbation of COPD (AECOPD) during various time periods. Methods We performed a prospective cohort study in which recruited patients with AECOPD. We systematically collected numerous clinical (symptoms, pulmonary function, comorbidities, and treatment) and social (financial situation, housing situation, family support, caregiver overload, ability to perform activities, and risk of social exclusion) variables using several questionnaires and indices. The patients were followed closely for one year and readmissions at 30, 60, and 365 days were analysed. Results 253 patients were included, aged 68.9±9.8years, FEV 1 = 42.1%±14.2%, and a Charlson's index = 1.8±0.9. Of these patients, 20.2%, 39.6%, and 63.7% were readmitted within the first 30, 90, and 365 days after discharge, respectively. In the multivariate model applied, the variables that were independently associated with readmission over all three periods of the analysis were dependence to perform basic activities of daily living (BADLs) (odds ratio [OR] = 2.10-4.10) and a history of two or more admissions within the previous year (OR = 2.78-3.78). At 90 days, a history of bacterial isolates in a previous sputum culture (OR = 2.39) and at 365 days, a high grade of dyspnoea (OR = 2.51) and obesity (OR = 2.38) were also identified as predictors of hospital readmission.

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Section: Discussionmentioning

confidence: 90%

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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“…On the one hand, the penalty could have encouraged hospitals and physicians to start to provide better care for COPD patients. Under pressure from clearly defined penalties, hospitals started to design readmission reduction programs, 41 and programs bearing a higher risk may increase the likelihood of reducing preventable readmissions. 34 But, on the other hand, hospitals may lower readmissions by shifting care to other high-resource settings such as observation stays or emergency room (ED) visits rather than delivering higher quality care, because these settings were exempt from the HRRP.…”

Section: Discussionmentioning

confidence: 99%

<p>Multi-morbidities are Not a Driving Factor for an Increase of COPD-Related 30-Day Readmission Risk</p>

Lin

Xue

Deng

et al. 2020

COPD

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Background and Objective: Chronic obstructive pulmonary disease (COPD) is the third leading cause of death in the United States. COPD is expensive to treat, whereas the quality of care is difficult to evaluate due to the high prevalence of multi-morbidity among COPD patients. In the US, the Hospital Readmissions Reduction Program (HRRP) was initiated by the Centers for Medicare and Medicaid Services to penalize hospitals for excessive 30-day readmission rates for six diseases, including COPD. This study examines the difference in 30-day readmission risk between COPD patients with and without comorbidities. Methods: In this retrospective cohort study, we used Cox regression to estimate the hazard ratio of 30-day readmission rates for COPD patients who had no comorbidity and those who had one, two or three, or four or more comorbidities. We controlled for individual, hospital and geographic factors. Data came from three sources: Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SID), Area Health Resources Files (AHRF) and the American Hospital Association's (AHA's) annual survey database for the year of 2013. Results: COPD patients with comorbidities were less likely to be readmitted within 30 days relative to patients without comorbidities (aHR from 0.84 to 0.87, p < 0.05). In a stratified analysis, female patients with one comorbidity had a lower risk of 30-day readmission compared to female patients without comorbidity (aHR = 0.80, p < 0.05). Patients with public insurance who had comorbidities were less likely to be readmitted within 30 days in comparison with those who had no comorbidity (aHR from 0.79 to 0.84, p < 0.05). Conclusion: COPD patients with comorbidities had a lower risk of 30-day readmission compared with patients without comorbidity. Future research could use a different study design to identify the effectiveness of the HRRP.

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“…COPD treatment may be a marker for persons with particularly severe disease, who are also more likely to have poor outcomes. Confounding characteristics related to readmissions after a COPD hospitalization include patient age, indicators of disease severity such as medications used, and comorbidities (in particular cardiovascular-related morbidities) [16,31,32]. Inadequate assessment and adjustment for biases can lead to false conclusions [33,34].…”

Section: Key Pointsmentioning

confidence: 99%

Comparative Causal Analysis of the Effects of Long-Acting Muscarinic Antagonist Versus No Long-Acting Bronchodilator Use on Readmission or Mortality After Hospitalization for Chronic Obstructive Pulmonary Disease

Roberts

Mapel

Petersen

2019

Drugs - Real World Outcomes

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Background Retrospective observational studies may provide real-world evidence about long-acting muscarinic receptor antagonist (LAMA) effectiveness in reducing mortality or COPD-related readmission risk after a COPD hospitalization. Causal inference and competing risk statistical procedures aid in managing confounding and competing outcome events that complicate retrospective analyses. Objective To compare COPD-related readmission and mortality risk among patients receiving a LAMA versus patients receiving no long-acting bronchodilator ("no LABD") within 30 days post-discharge. Methods This retrospective observational analysis of patients (aged ≥ 40 years) hospitalized for COPD used claims data (years 2004-2012). Events occurring during the period from 31 days through 12 months post-discharge were compared. The hazard ratio (HR) for the combined outcome of COPD-related readmission or mortality was estimated using Cox regression. Confounding was addressed using inverse probability of treatment weighting (IPTW). The competing risk of non-COPDrelated readmission was considered. Results 10,405 COPD patients were included (LAMA = 751, no LABD = 9654). IPTW achieved a balanced sample (10,518 LAMA, 10,405 no LABD). Unweighted HR (LAMA vs no LABD) for COPD-related readmission or death, adjusted for age, sex, comorbidities, and baseline utilization, was 1.00 [95% confidence interval (CI) 0.84, 1.20]. Weighted (IPTW) adjusted HR was 0.94 (95% CI 0.88, 1.00). Unweighted and weighted HRs further adjusted for competing risk were 0.97 (95% CI 0.82, 1.16) and 0.91 (0.86, 0.98), respectively. Conclusions Bias by indication and comorbidities make the measurement of retrospective COPD treatment effectiveness difficult. Using IPTW and additionally considering the competing event risk, LAMA use was associated with a small reduction in risk for COPD-related readmission or death over the period from 31 days to 12 months post-discharge.

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Reducing Chronic Obstructive Pulmonary Disease Hospital Readmissions. An Official American Thoracic Society Workshop Report

Cited by 68 publications

References 52 publications

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

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

<p>Multi-morbidities are Not a Driving Factor for an Increase of COPD-Related 30-Day Readmission Risk</p>

Comparative Causal Analysis of the Effects of Long-Acting Muscarinic Antagonist Versus No Long-Acting Bronchodilator Use on Readmission or Mortality After Hospitalization for Chronic Obstructive Pulmonary Disease

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