Model Predicts COPD Hospital Readmission
Guideline-adherent management and early follow-up reduce rehospitalizations, authors find
Researchers at the University of Texas Medical Branch at Galveston have identified predictors of early rehospitalization among patients hospitalized for complications of chronic obstructive pulmonary disease (COPD).
The study was published in the June 2014 issue of the Annals of the American Thoracic Society.
In a nationwide analysis of more than 8,000 commercially insured adult patients with COPD, the researchers concluded that several modifiable factors, such as appropriate prescriptions on discharge and early follow-up after discharge, were associated with a lower likelihood of early readmission.
COPD affects between 12 million and 24 million individuals and is the third leading cause of death in the U.S. Each year, thousands of people have acute COPD flare-ups that require hospitalization. According to the authors, about 20% of these patients require readmission within 30 days of discharge.
The study finds that high rates of hospital readmissions and differences in those rates may stem from patient-specific factors, including the severity of COPD, the presence of other aggravating health conditions, factors related to health care providers and the quality of care, outpatient follow-up, and the availability of subspecialty referrals. These early readmissions result in overuse of health care resources and impose a heavy financial burden.
Reducing hospital readmissions has been a key objective of the Patient Protection and Affordable Care Act and of accountable care organizations. In 2009, the U.S. Centers for Medicare and Medicaid Services (CMS) began to report publicly 30-day readmission rates for heart attacks, pneumonia, and congestive heart failure as quality performance measures. In 2012, the CMS started to reduce Medicare payments to hospitals with high readmission rates for patients admitted with these conditions. Beginning in October 2014, COPD will be added to the list.
“This study analyzed a nationwide sample with robust design methods to confirm patient factors as a predictor of early readmission after initial hospitalization for COPD, as well as to show how a combination of different factors can independently contribute to early readmission,” said lead author Dr. Roozbeh Sharif. He added: “Guideline-adherent management and early follow-up has the potential to reduce early rehospitalization among COPD patients.”
COPD patients with co-existing congestive heart failure, lung cancer, anxiety, depression, or osteoporosis were associated with a higher likelihood of early readmission. Health care provider and system factors, including prescriptions for bronchodilator inhalers, oral corticosteroids, antibiotics at discharge, and an early outpatient follow-up after discharge were associated with a lower likelihood of readmission.
According to the authors, their study suggests that strategies to reduce hospital readmissions soon after COPD flare-ups are likely to be more effective when they extend beyond the quality of COPD-specific care in the hospital.