Understanding Why Patients With COPD Get Readmitted

Shah, Tina; Churpek, Matthew M.; Perraillon, Marcelo Coca; Konetzka, R. Tamara

doi:10.1378/chest.14-2181

Cited by 179 publications

(90 citation statements)

References 23 publications

(19 reference statements)

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“…The results of this study extend the findings of previous research reporting a strong association between post-discharge care including early follow-up with lower risk of readmission 29,36–39. Sharma et al36 reported that early follow-up visits with patient’s PCP significantly reduced risk of ED visits and readmissions within 30 days following acute hospitalization.…”

Section: Discussionsupporting

confidence: 86%

“…Results from several observational studies showed that more than one-half of COPD exacerbations were not reported to health care providers and that these had significant impact on health status 39,40. Wilkinson et al34 found that failure to report exacerbations was associated with an increased risk of hospitalization, while earlier treatment of COPD exacerbation accelerates recovery time.…”

Section: Discussionmentioning

confidence: 99%

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Impact of a COPD comprehensive case management program on hospital length of stay and readmission rates

Alshabanat¹,

Otterstatter²,

Sin³

et al. 2017

COPD

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BackgroundCOPD accounts for the highest rate of hospital admissions among major chronic diseases. COPD hospitalizations are associated with impaired quality of life, high health care utilization, and poor prognosis and result in an economic and a social burden that is both substantial and increasing.AimThe aim of this study is to determine the efficacy of a comprehensive case management program (CCMP) in reducing length of stay (LOS) and risk of hospital admissions and readmissions in patients with COPD.Materials and methodologyWe retrospectively compared outcomes across five large hospitals in Vancouver, BC, Canada, following the implementation of a systems approach to the management of COPD patients who were identified in the hospital and followed up in the community for 90 days. We compared numbers, rates, and intervals of readmission and LOS during 2 years of active program delivery compared to 1 year prior to program implementation.ResultsA total of 1,564 patients with a clinical diagnosis of COPD were identified from 2,719 hospital admissions during the 3 years of study. The disease management program reduced COPD-related hospitalizations by 30% and hospitalizations for all causes by 13.6%. Similarly, the rate of readmission for all causes showed a significant decline, with hazard ratios (HRs) of 0.55 (year 1) and 0.51 (year 2) of intervention (P<0.001). In addition, patients’ mean LOS (days) for COPD-related admissions declined significantly from 10.8 to 6.8 (P<0.05).ConclusionA comprehensive disease management program for COPD patients, including education, case management, and follow-up, was associated with significant reduction in hospital admissions and LOS.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Impact of a COPD comprehensive case management program on hospital length of stay and readmission rates

Alshabanat¹,

Otterstatter²,

Sin³

et al. 2017

COPD

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“…15 After exacerbations of chronic obstructive pulmonary disease, readmission is more common among patients eligible for both Medicare and Medicaid, a marker of lower socioeconomic status. 16 Available data on PCI readmission suggest correlations with race and insurance status, with black patients nearly twice as likely to experience hospital readmission. 17 In addition to patient characteristics, hospital characteristics appear to be correlated with readmission.…”

Section: Lessons From Other Readmission Metricsmentioning

confidence: 99%

Future of the PCI Readmission Metric

Wasfy

Yeh

2016

Circ: Cardiovascular Quality and Outcomes

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Abstract-Between 2013 and 2014, the Centers for Medicare and Medicaid Services and the National Cardiovascular DataRegistry publically reported risk-adjusted 30-day readmission rates after percutaneous coronary intervention (PCI) as a pilot project. A key strength of this public reporting effort included risk adjustment with clinical rather than administrative data. Furthermore, because readmission after PCI is common, expensive, and preventable, this metric has substantial potential to improve quality and value in American cardiology care. Despite this, concerns about the metric exist. For example, few PCI readmissions are caused by procedural complications, limiting the extent to which improved procedural technique can reduce readmissions. Also, similar to other readmission measures, PCI readmission is associated with socioeconomic status and race. Accordingly, the metric may unfairly penalize hospitals that care for underserved patients. Perhaps in the context of these limitations, Centers for Medicare and Medicaid Services has not yet included PCI readmission among metrics that determine Medicare financial penalties. Nevertheless, provider organizations may still wish to focus on this metric to improve value for cardiology patients. PCI readmission is associated with low-risk chest discomfort and patient anxiety. Therefore, patient education, improved triage mechanisms, and improved care coordination offer opportunities to minimize PCI readmissions. Because PCI readmission is common and costly, reducing PCI readmission offers provider organizations a compelling target to improve the quality of care, and also performance in contracts involve shared financial risk. (Circ Cardiovasc Qual Outcomes. 2016;9:186-189.

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“…[14][15][16] Recent studies have suggested that the addition of COPD to the diagnoses included in the calculation of readmission penalties will only further harm hospitals serving large numbers of low SES patients. [17,18] Given the increasing penalties levied on institutions serving socioeconomically disadvantaged populations, the evaluation of relevant predictor variables for readmission in high-risk patients within low SES population has become an important topic for investigation. The purpose of the current study was to examine risk factors associated with 0-30-(30), 31-60-(60), and 61-90-(90) day all-cause hospital readmission in an underserved, socioeconomically disadvantaged patient population.…”

Section: Introductionmentioning

confidence: 99%

Risk predictors for hospital readmission in a low socio-economic and underserved population

Couch

Peterson

Bowden

et al. 2018

JHA

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Objective: Hospital readmissions are significant and potentially preventable sources of healthcare cost in the United States. The Affordable Care Act (ACA) establishes the Hospital Readmissions Reduction Program (HRRP) in an attempt to reduce readmissions by penalizing institutions whose 30-day readmission rates are above the national average. The current study examines demographic and clinical variables associated with early hospital readmission in a low socioeconomic status, underserved population. Methods: A secondary data analysis was conducted of 2,536 patients from the acute primary care facilities who were hospitalized. Age, sex, race, ethnicity, smoking status, systolic blood pressure, diastolic blood pressure, body temperature, pulse rate, and days to follow up visit were analyzed in a sample of 2,536 hospitalized patients at or below 200% of federal poverty guidelines in Central Texas to determine association with risk of 0-30-(30), 31-60-(60) and 61-90-(90) day all-cause readmission. Results: Multinomial statistical analysis found pulse rate was associated with 30-, 60-, and 90-day readmission as compared to a control group. Days to follow-up were associated with decreased risk of readmission in all groups, and passive smoking status was associated with decreased risk of 90-day readmission as compared to a control group. Conclusions: Results offer healthcare providers with tools for potentially identifying patients at elevated risk for readmission in a disadvantaged population and suggest further investigation of other clinical and laboratory variables as predictors of readmission risk.

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Understanding Why Patients With COPD Get Readmitted

Cited by 179 publications

References 23 publications

Impact of a COPD comprehensive case management program on hospital length of stay and readmission rates

Impact of a COPD comprehensive case management program on hospital length of stay and readmission rates

Future of the PCI Readmission Metric

Risk predictors for hospital readmission in a low socio-economic and underserved population

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