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Bogart M, Leung GYH, Cyhaniuk A, DiRocco K. Inpatient Admissions and Re-Admissions in Medicare Beneficiaries Initiating Umeclidinium/Vilanterol or Tiotropium Therapy. Int J Chron Obstruct Pulmon Dis 2024; 19:439-450. [PMID: 38374817 PMCID: PMC10874883 DOI: 10.2147/copd.s436654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 01/10/2024] [Indexed: 02/21/2024] Open
Abstract
Purpose Patients with chronic obstructive pulmonary disease (COPD) who are hospitalized are more likely to die from their illness and have increased likelihood of re-admission than those who are not. Subsequent re-admissions further increase the burden on healthcare systems. This study compared inpatient admission rates and time-to-first COPD-related inpatient admission among Medicare beneficiaries with COPD indexed on umeclidinium/vilanterol (UMEC/VI) versus tiotropium (TIO). Patients and Methods This retrospective study used the All-Payer Claims Database to investigate hospital admission and re-admission outcomes in Medicare beneficiaries with COPD with an initial pharmacy claim for UMEC/VI or TIO from 1 January 2015 to 28 February 2020. Inpatient admissions, baseline, and follow-up variables were assessed in patients indexed on UMEC/VI and TIO after propensity score matching (PSM), with time-to-first on-treatment COPD-related inpatient admission as the primary endpoint. Re-admissions were assessed among patients with a COPD-related inpatient admission in the 30- and 90-days post-discharge. Results Post-PSM, 7152 patients indexed on UMEC/VI and 7069 on TIO were eligible for admissions analysis. The mean (standard deviation [SD]) time-to-first COPD-related inpatient admission was 46.71 (87.99) days for patients indexed on UMEC/VI and 44.96 (85.90) days for those on TIO (p=0.06). The mean (SD) number of inpatient admissions per patient was 1.24 (2.92) for patients indexed on UMEC/VI and 1.26 (3.05) for those on TIO (p=0.49). Proportion of patients undergoing re-admissions was similar between treatments over both 30 and 90 days, excluding a significantly lower proportion of patients indexed on UMEC/VI than those indexed on TIO for COPD-related re-admissions for hospital stays of 4-7 days and 7-14 days, and all-cause re-admissions for stays of 4-7 days. Conclusion Patients with COPD using Medicare in the US and receiving UMEC/VI or TIO reported similar time-to-first inpatient admission and similar proportion of re-admissions.
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Affiliation(s)
- Michael Bogart
- Customer Engagement, Value, Evidence and Outcomes (CEVEO) US Medical Affairs, GSK, Research Triangle Park, NC, USA
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2
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Chow R, So OW, Im JHB, Chapman KR, Orchanian-Cheff A, Gershon AS, Wu R. Predictors of Readmission, for Patients with Chronic Obstructive Pulmonary Disease (COPD) - A Systematic Review. Int J Chron Obstruct Pulmon Dis 2023; 18:2581-2617. [PMID: 38022828 PMCID: PMC10664718 DOI: 10.2147/copd.s418295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 08/08/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Chronic obstructive pulmonary disease (COPD) is the third-leading cause of death globally and is responsible for over 3 million deaths annually. One of the factors contributing to the significant healthcare burden for these patients is readmission. The aim of this review is to describe significant predictors and prediction scores for all-cause and COPD-related readmission among patients with COPD. Methods A search was conducted in Ovid MEDLINE, Ovid Embase, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials, from database inception to June 7, 2022. Studies were included if they reported on patients at least 40 years old with COPD, readmission data within 1 year, and predictors of readmission. Study quality was assessed. Significant predictors of readmission and the degree of significance, as noted by the p-value, were extracted for each study. This review was registered on PROSPERO (CRD42022337035). Results In total, 242 articles reporting on 16,471,096 patients were included. There was a low risk of bias across the literature. Of these, 153 studies were observational, reporting on predictors; 57 studies were observational studies reporting on interventions; and 32 were randomized controlled trials of interventions. Sixty-four significant predictors for all-cause readmission and 23 for COPD-related readmission were reported across the literature. Significant predictors included 1) pre-admission patient characteristics, such as male sex, prior hospitalization, poor performance status, number and type of comorbidities, and use of long-term oxygen; 2) hospitalization details, such as length of stay, use of corticosteroids, and use of ventilatory support; 3) results of investigations, including anemia, lower FEV1, and higher eosinophil count; and 4) discharge characteristics, including use of home oxygen and discharge to long-term care or a skilled nursing facility. Conclusion The findings from this review may enable better predictive modeling and can be used by clinicians to better inform their clinical gestalt of readmission risk.
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Affiliation(s)
- Ronald Chow
- University Health Network, University of Toronto, Toronto, ON, Canada
| | - Olivia W So
- University Health Network, University of Toronto, Toronto, ON, Canada
| | - James H B Im
- The Hospital for Sick Children, Toronto, ON, Canada
| | - Kenneth R Chapman
- University Health Network, University of Toronto, Toronto, ON, Canada
| | | | - Andrea S Gershon
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Robert Wu
- University Health Network, University of Toronto, Toronto, ON, Canada
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Kee YS, Wong CK, Abdul Aziz MA, Zakaria MI, Mohd Shaarif F, Ng KS, Liam CK, Pang YK, Khoo EM. 30-Day Readmission Rate of Patients with COPD and Its Associated Factors: A Retrospective Cohort Study from a Tertiary Care Hospital. Int J Chron Obstruct Pulmon Dis 2023; 18:2623-2631. [PMID: 38022826 PMCID: PMC10658934 DOI: 10.2147/copd.s429108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 11/09/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose Readmission of chronic obstructive pulmonary disease (COPD) has been used as a measure of performance for COPD care. This study aimed to determine the rate of readmission of COPD in tertiary care hospital in Malaysia and its associated factors. Patients and Methods A retrospective cohort study was conducted at a tertiary care hospital in Malaysia from 1st January to 21st May 2019. Seventy admissions for COPD exacerbation involving 58 patients were analyzed. Results The majority of the patients were male (89.8%), had a mean age of 71.95 ± 7.24 years and a median smoking history of 40 (IQR = 25) pack-years, 84.5% were in GOLD group D and 91.4% had a mMRC grading of 2 or greater. Approximately 60.3% had upper or lower respiratory tract infection as the cause of exacerbation; one in five patients had uncompensated hypercapnic respiratory failure at presentation, and 27.6% needed mechanical ventilatory support. Approximately 43.1% of patients had a history of exacerbation that required hospitalisation in the past year. The mean blood eosinophil concentration was 0.38 ± 0.46 x109 cells/L. The 30-day readmission rate was 20.3%, revisit rate to the emergency room within 30 days after discharge was 3.4%, and in-hospital mortality rate was 1.7%. Among all characteristics, a higher baseline mMRC grade (p = 0.038) and history of exacerbation in the past 1 year (p < 0.001) were statistically associated with 30-day readmission. Conclusion The 30-day readmission rate for COPD exacerbation in a Malaysian tertiary hospital is similar to the rates in high-income countries. Exacerbation in the previous year and a higher baseline mMRC grading were significant risk factors for 30-day readmission in patients with COPD. Strategies of COPD management should concentrate on improvement of symptoms control by optimisation of pharmacotherapy, and early initiation of pulmonary rehabilitation, and structured integrated care programs to reduce readmission rates.
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Affiliation(s)
- Yan Shen Kee
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chee Kuan Wong
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Mohd Idzwan Zakaria
- Academic Unit Trauma and Emergency, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Fatimah Mohd Shaarif
- Academic Unit Trauma and Emergency, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kee Seong Ng
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chong Kin Liam
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Yong Kek Pang
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ee Ming Khoo
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Burnett A, Wewerka S, Miller P, Majerus A, Clark J, Crippes L, Radant T. Community Paramedicine Intervention Reduces Hospital Readmission and Emergency Department Utilization for Patients with Cardiopulmonary Conditions. West J Emerg Med 2023; 24:786-792. [PMID: 37527389 PMCID: PMC10393450 DOI: 10.5811/westjem.57862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 05/01/2023] [Indexed: 08/03/2023] Open
Abstract
OBJECTIVE Patients discharged from the hospital with diagnoses of myocardial infarction, congestive heart failure or acute exacerbation of chronic obstructive pulmonary disease (COPD) have high rates of readmission. We sought to quantify the impact of a community paramedicine (CP) intervention on hospital readmission and emergency department (ED) and clinic utilization for patients discharged with these conditions and to calculate the difference in healthcare costs. METHODS This was a prospective, observational cohort study with a matched historical control. The groups were matched for qualifying diagnosis, age, gender, and ZIP code. The intervention group received 1-2 home visits per week by a community paramedic for 30 days. We calculated the number of all-cause hospital readmissions and ED and clinic visits, and used descriptive statistics to compare cohorts. RESULTS Included in the study were 78 intervention patients and 78 controls. Compared to controls, fewer subjects in the CP cohort had experienced a readmission at 120 days (34.6% vs 64.1%, P < 0.001) and 210 days (43.6% vs 75.6%, P < 0.001) after discharge. At 210 days the CP cohort had 40.9% fewer total hospital admissions, saving 218 bed days and $410,428 in healthcare costs. The CP cohort had 40.7% fewer total ED visits. CONCLUSION Patients who received a post-hospital community paramedic intervention had fewer hospital readmissions and ED visits, which resulted in saving 218 bed days and decreasing healthcare costs by $410,428. Incorporation of a home CP intervention of 30 days in this patient population has the potential to benefit payors, hospitals, and patients.
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Affiliation(s)
| | - Sandi Wewerka
- Critical Care Research Center, Regions Hospital, St. Paul, Minnesota
| | - Paula Miller
- Critical Care Research Center, Regions Hospital, St. Paul, Minnesota
| | - Ann Majerus
- Regions Hospital, St. Paul, Minnesota
- St. Paul Fire Department, St. Paul, Minnesota
| | | | - Landon Crippes
- Critical Care Research Center, Regions Hospital, St. Paul, Minnesota
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Eseaton PO, Enosolease AU, Ijioma O, Ugoh AC, Onyeaka H, Oladunjoye AF, Anugwom G, Osiezagha K, Edigin E. Severe major depressive disorder readmissions: A national United States population study. J Affect Disord 2023; 333:177-180. [PMID: 37086795 DOI: 10.1016/j.jad.2023.04.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 04/07/2023] [Accepted: 04/16/2023] [Indexed: 04/24/2023]
Abstract
BACKGROUND National population data are scarce on readmission following hospitalization for severe major depressive disorder (SMDD) in the United States (U.S.). We aim to describe the rates, characteristics, and reasons for readmissions for adults hospitalized for SMDD in the U.S. METHODS We analyzed the 2018 Nationwide Readmissions Database (NRD). We included index hospitalizations for all adult patients (≥18 years) with a "principal" diagnosis of SMDD using (ICD)-10 codes. We excluded elective readmissions. Chi-square tests were used to compare baseline characteristics between readmissions and index hospitalizations. The 10 most common reasons for readmission were highlighted. RESULTS A total of 236,284, 185,737, 120,218, and 21,645 index hospitalizations with a principal diagnosis of SMDD discharged alive, were included in the 30-, 90-180- and 330-day readmission analysis. Among these, 27,443 (11.6 %), 36,844 (19.8 %), 32,269 (26.8 %) and 7915 (36.6 %) were readmitted within 30, 90, 180 and 330 days, respectively. 90-day readmissions were older, had more males, greater hospital costs, fewer patients with private insurance, higher comorbidity burden, more patients from lower-income households, present to metropolitan hospitals, and leave against medical advice compared to index admissions. LIMITATIONS Limitations of our study include possible coding errors, lack of data on race/ethnicity, age of disease onset, duration of illness, medication use, and adherence. CONCLUSIONS About 1 in 3 patients admitted for SMDD are readmitted within 11 months. Readmissions constitute a significant economic burden and differ from index admissions. SMDD and other psychiatric disorders are common reasons for readmission. Interventions to reduce readmissions are needed.
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Affiliation(s)
| | | | - Oyidia Ijioma
- Department of Clinical Psychiatry, University of South Wales, Wales, United Kingdom
| | - Amaka Cynthia Ugoh
- Department of Family Medicine, University of Benin Teaching Hospital, Benin, Nigeria
| | - Henry Onyeaka
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, McLean Hospital, Belmont, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | | | - Gibson Anugwom
- Menninger Department of Psychiatry, Baylor College of Medicine, Houston, TX, USA
| | - Kenneth Osiezagha
- Department of Psychiatry, Meharry Medical College, Nashville, TN, USA
| | - Ehizogie Edigin
- Department of Medicine, Loma Linda University Health, Loma Linda, CA, USA
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6
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Douin DJ, Siegel L, Grandits G, Phillips A, Aggarwal NR, Baker J, Brown SM, Chang CC, Goodman AL, Grund B, Higgs ES, Hough CL, Murray DD, Paredes R, Parmar M, Pett S, Polizzotto MN, Sandkovsky U, Self WH, Young BE, Babiker AG, Davey VJ, Kan V, Gelijns AC, Matthews G, Thompson BT, Lane HC, Neaton JD, Lundgren JD, Ginde AA. Evaluating Primary Endpoints for COVID-19 Therapeutic Trials to Assess Recovery. Am J Respir Crit Care Med 2022; 206:730-739. [PMID: 35580040 PMCID: PMC9799123 DOI: 10.1164/rccm.202112-2836oc] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Rationale: Uncertainty regarding the natural history of coronavirus disease (COVID-19) led to difficulty in efficacy endpoint selection for therapeutic trials. Capturing outcomes that occur after hospital discharge may improve assessment of clinical recovery among hospitalized patients with COVID-19. Objectives: Evaluate 90-day clinical course of patients hospitalized with COVID-19, comparing three distinct definitions of recovery. Methods: We used pooled data from three clinical trials of neutralizing monoclonal antibodies to compare: 1) the hospital discharge approach; 2) the TICO (Therapeutics for Inpatients with COVID-19) trials sustained recovery approach; and 3) a comprehensive approach. At the time of enrollment, all patients were hospitalized in a non-ICU setting without organ failure or major extrapulmonary manifestations of COVID-19. We defined discordance as a difference between time to recovery. Measurements and Main Results: Discordance between the hospital discharge and comprehensive approaches occurred in 170 (20%) of 850 enrolled participants, including 126 hospital readmissions and 24 deaths after initial hospital discharge. Discordant participants were older (median age, 68 vs. 59 years; P < 0.001) and more had a comorbidity (84% vs. 70%; P < 0.001). Of 170 discordant participants, 106 (62%) had postdischarge events captured by the TICO approach. Conclusions: Among patients hospitalized with COVID-19, 20% had clinically significant postdischarge events within 90 days after randomization in patients who would be considered "recovered" using the hospital discharge approach. Using the TICO approach balances length of follow-up with practical limitations. However, clinical trials of COVID-19 therapeutics should use follow-up times up to 90 days to assess clinical recovery more accurately.
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Affiliation(s)
| | | | | | | | - Neil R. Aggarwal
- Division of Pulmonary Sciences and Critical Care, Department of Medicine, and
| | - Jason Baker
- Department of Medicine, School of Medicine, and,Hennepin Healthcare Research Institute, Minneapolis, Minnesota
| | - Samuel M. Brown
- Division of Pulmonary and Critical Care Medicine, Intermountain Medical Center, Murray, Utah;,Department of Internal Medicine, University of Utah, Murray, Utah
| | - Christina C. Chang
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Anna L. Goodman
- The Medical Research Council Clinical Trials Unit at UCL, University College London, London, United Kingdom;,Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Birgit Grund
- School of Statistics, University of Minnesota, Minneapolis, Minnesota
| | - Elizabeth S. Higgs
- National Institute of Allergy and Infectious Diseases, Bethesda, Maryland
| | - Catherine L. Hough
- Department of Medicine, Oregon Health and Sciences University, Portland, Oregon
| | - Daniel D. Murray
- CHIP Center of Excellence for Health, Immunity, and Infections, and,Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Roger Paredes
- Hospital Germans Trias i Pujol, Badalona, Spain;,irsiCaixa AIDS Research Institute, Badalona, Spain
| | - Mahesh Parmar
- John Curtin School of Medical Research, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Sarah Pett
- John Curtin School of Medical Research, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Mark N. Polizzotto
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia;,John Curtin School of Medical Research, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Uriel Sandkovsky
- Division of Infectious Diseases, Baylor University Medical Center, Dallas, Texas
| | - Wesley H. Self
- Department of Emergency Medicine and,Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Barnaby E. Young
- National Centre for Infectious Diseases, Singapore;,Tan Tock Seng Hospital, Singapore;,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Abdel G. Babiker
- John Curtin School of Medical Research, The Australian National University, Canberra, Australian Capital Territory, Australia
| | | | - Virginia Kan
- Infectious Diseases Section, VA Medical Center, Washington, DC
| | - Annetine C. Gelijns
- Department of Population Heath Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York; and
| | - Gail Matthews
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - B. Taylor Thompson
- Division of Pulmonary and Critical Care, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - H. Clifford Lane
- National Institute of Allergy and Infectious Diseases, Bethesda, Maryland
| | | | - Jens D. Lundgren
- CHIP Center of Excellence for Health, Immunity, and Infections, and,Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Adit A. Ginde
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado
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Burkes RM, Couper DJ, Barjaktarevic IZ, Cooper CB, Labaki WW, Han MK, Woodruff PG, Lazarus SC, Parekh TM, Paine, III R, Comellas AP, Bowler RP, Loehr LR, Putcha N, Wise RA, Brown TT, Drummond MB. Age-Dependent Associations Between 25-Hydroxy Vitamin D Levels and COPD Symptoms: Analysis of SPIROMICS. CHRONIC OBSTRUCTIVE PULMONARY DISEASES (MIAMI, FLA.) 2021; 8:277-291. [PMID: 33829714 PMCID: PMC8237982 DOI: 10.15326/jcopdf.2020.0180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/31/2021] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Age and vitamin D levels may affect symptom burden in chronic obstructive pulmonary disease (COPD). We used the Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS) to determine independent associations between vitamin D levels and COPD symptoms in different age strata. METHODS Serum 25-hydroxy (OH)-vitamin D levels were modeled continuously and categorically (<20 ng/ml versus ≥20 ng/ml). Stratifying by age group (middle-age: 40-64 years old and older: >65 years old), multivariable modeling was performed to identify relationships between 25-OH-vitamin D levels and the COPD Assessment Test (CAT), the modified Medical Research Council score (mMRC), the St George's Respiratory Questionnaire (SGRQ) total and subdomain scores, the Veterans' Specific Activity Questionnaire, and the 6-minute walk test distance. RESULTS InIn the middle-aged group, each 5 ng/ml higher 25-OH-vitamin D level was independently associated with more favorable CAT score (-0.35 [-0.67 to -0.03], P=0.03), total SGRQ (-0.91 [-1.65 to -0.17]; P=0.02), and the SGRQ subdomains (Symptoms:-1.07 [-1.96 to -0.18], P=0.02; Impact: -0.77 [-1.53 to -0.003], P=0.049; Activity: -1.07 [-1.96 to -0.18], P=0.02). These associations persisted after the addition of comorbidity score, reported vitamin D supplementation, outdoor time, or season of blood draw to models. No associations were observed between 25-OH-vitamin D levels and symptom scores in the older age group. DISCUSSION When controlled for clinically relevant covariates, higher 25-OH-vitamin D levels are associated with more favorable respiratory-specific symptoms and quality-of-life assessments in middle-age but not older COPD individuals. Study of the role of vitamin D supplementation in the symptom burden of younger COPD patients is needed.
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Affiliation(s)
- Robert M. Burkes
- Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States
| | - David J. Couper
- Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States
| | - Igor Z. Barjaktarevic
- Division of Pulmonary, Critical Care, and Sleep Medicine, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California, United States
| | - Christopher B. Cooper
- Departments of Medicine and Physiology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California, United States
| | - Wassim W. Labaki
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan, United States
| | - Meilan K. Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan, United States
| | - Prescott G. Woodruff
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, University of California-San Francisco, San Francisco, California, United States
| | - Stephen C. Lazarus
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, University of California-San Francisco, San Francisco, California, United States
| | - Trisha M. Parekh
- Division of Pulmonary, Critical Care, Allergy, and Sleep Medicine, University of Alabama-Birmingham, Birmingham, Alabama, United States
| | - Robert Paine, III
- Division of Pulmonary Medicine, University of Utah, Salt Lake City, Utah, United States
| | - Alejandro P. Comellas
- Division of Pulmonary, Critical Care, and Occupational Medicine, University of Iowa, Iowa City, Iowa, United States
| | - Russell P. Bowler
- Division of Pulmonary, Critical Care, and Sleep Medicine, National Jewish Hospital, Denver, Colorado, United States
| | - Laura R. Loehr
- Division of General Medicine and Clinical Epidemiology, University of North Carolina, Chapel Hill, North Carolina, United States
| | - Nirupama Putcha
- Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore, Maryland, United States
| | - Robert A. Wise
- Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore, Maryland, United States
| | - Todd T. Brown
- Division of Endocrinology and Metabolism, Johns Hopkins University, Baltimore, Maryland, United States
| | - M. Bradley Drummond
- Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States
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8
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Witt LJ, Spacht WA, Carey KA, Arora VM, White SR, Huisingh-Scheetz M, Press VG. Weak Handgrip at Index Admission for Acute Exacerbation of COPD Predicts All-Cause 30-Day Readmission. Front Med (Lausanne) 2021; 8:611989. [PMID: 33898475 PMCID: PMC8058414 DOI: 10.3389/fmed.2021.611989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 03/10/2021] [Indexed: 12/30/2022] Open
Abstract
Rationale: Identifying patients hospitalized for acute exacerbations of COPD (AECOPD) who are at high risk for readmission is challenging. Traditional markers of disease severity such as pulmonary function have limited utility in predicting readmission. Handgrip strength, a component of the physical frailty phenotype, may be a simple tool to help predict readmission. Objective(s): To investigate if handgrip strength, a component of the physical frailty phenotype and surrogate for weakness, is a predictive biomarker of COPD readmission. Methods: This was a prospective, observational study of patients admitted to the inpatient general medicine unit at the University of Chicago Medicine, US. This study evaluated age, sex, ethnicity, degree of obstructive lung disease by spirometry (FEV1 percent predicted), and physical frailty phenotype (components include handgrip strength and walk speed). The primary outcome was all-cause hospital readmission within 30 days of discharge. Results: Of 381 eligible patients with AECOPD, 70 participants agreed to consent to participate in this study. Twelve participants (17%) were readmitted within 30 days of discharge. Weak grip at index hospitalization, defined as grip strength lower than previously established cut-points for sex and body mass index (BMI), was predictive of readmission (OR 11.2, 95% CI 1.3, 93.2, p = 0.03). Degree of airway obstruction (FEV1 percent predicted) did not predict readmission (OR 1.0, 95% CI 0.95, 1.1, p = 0.7). No non-frail patients were readmitted. Conclusions: At a single academic center weak grip strength was associated with increased 30-day readmission. Future studies should investigate whether geriatric measures can help risk-stratify patients for likelihood of readmission after admission for AECOPD.
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Affiliation(s)
- Leah J. Witt
- Divisions of Geriatrics and Pulmonary, Critical Care, Allergy and Sleep Medicine, University of California, San Francisco, San Francisco, CA, United States
| | | | - Kyle A. Carey
- Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Vineet M. Arora
- Department of Medicine, University of Chicago, Chicago, IL, United States
| | - Steven R. White
- Department of Medicine, University of Chicago, Chicago, IL, United States
| | | | - Valerie G. Press
- Department of Medicine, University of Chicago, Chicago, IL, United States
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9
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Hospital Admission and Readmission Among US Patients Receiving Umeclidinium/Vilanterol or Tiotropium as Initial Maintenance Therapy for Chronic Obstructive Pulmonary Disease. Pulm Ther 2021; 7:203-219. [PMID: 33728597 PMCID: PMC8137777 DOI: 10.1007/s41030-021-00151-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 02/15/2021] [Indexed: 11/15/2022] Open
Abstract
Introduction Patients hospitalized for chronic obstructive pulmonary disease (COPD) exacerbations are at risk of further readmissions, increased treatment costs, and excess mortality. This study evaluated inpatient admissions and readmissions in patients receiving initial maintenance therapy with umeclidinium/vilanterol (UMEC/VI) versus tiotropium (TIO). Methods This retrospective, matched cohort study identified patients with COPD who initiated maintenance therapy with UMEC/VI or TIO from Optum’s de-identified Clinformatics Data Mart database between January 1, 2013, and December 31, 2018 (index date defined as earliest dispensing). Eligibility criteria included: ≥ 1 medical claim for COPD pre-index or on the index date; ≥ 12 months of continuous eligibility pre-index; age ≥ 40 years at index; no pre- or post-index asthma diagnosis; and no pre-index claims for medications containing inhaled corticosteroids, long-acting β2-agonists, or long-acting muscarinic antagonists. Outcomes included time to first on-treatment COPD-related inpatient admission, rate of on-treatment COPD-related admissions, and rate of all-cause and COPD-related readmissions within 30 and 90 days. Propensity score matching was used to adjust for potential confounders. Results Matched UMEC/VI and TIO cohorts each included 7997 patients and were balanced on baseline characteristics (mean age 70.9 years; female 47.1–47.6%). Over 12 months, patients initiating UMEC/VI had significantly reduced risk (hazard ratio [95% CI]: 0.87 [0.79, 0.96]; p = 0.006) and rates (rate ratio [95% CI]: 0.80 [0.72, 0.92]; p = 0.008) of COPD-related inpatient admissions compared with TIO. While all-cause readmission rates were similar between treatment cohorts, readmission rates among patients with an initial admission length of stay of 1–3 days were numerically lower for UMEC/VI versus TIO (30-day readmissions: 10.5% vs. 12.4%; 90-day readmissions: 15.5% vs. 19.8%). Similar patterns were observed for COPD-related readmissions. Conclusions These findings highlight the real-world benefits of dual therapy with UMEC/VI versus TIO in reducing inpatient admissions and readmissions in patients with COPD, which may translate to lower healthcare costs. Supplementary Information The online version contains supplementary material available at 10.1007/s41030-021-00151-y. Patients with chronic obstructive pulmonary disease (COPD) who are admitted to the hospital are more likely to be readmitted in the future, have higher healthcare costs, and are more likely to die from their illness. Patients who are readmitted to hospital have even higher treatment costs. Identifying which treatments are best at reducing the number of patients with COPD who are admitted to the hospital may help to improve outcomes and reduce the cost of COPD treatment. We used US healthcare claims data to compare two daily treatments for COPD, umeclidinium/vilanterol and tiotropium. We aimed to find out which treatment was more effective at reducing hospital admissions due to COPD. We also compared how many patients on each treatment were readmitted within 30 or 90 days of their original hospital admission for COPD. We found that patients who started treatment with umeclidinium/vilanterol were less likely to be admitted to the hospital for COPD than patients who started treatment with tiotropium. Similar numbers of patients on each treatment were readmitted to the hospital within 30 or 90 days after they were discharged. However, among patients whose initial hospital stay was short (1–3 days), readmissions within 30 or 90 days were less common with umeclidinium/vilanterol than tiotropium. These findings suggest that umeclidinium/vilanterol may be more effective than tiotropium at reducing the number of patients with COPD who need to be admitted or readmitted to hospital. Starting COPD treatment with umeclidinium/vilanterol may lead to better health outcomes and lower costs than tiotropium.
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Sabahi A, Hosseini A, Emami H, Almasi S. Telemedicine Services in Chronic Obstructive Pulmonary Disease: A Systematic Review of Patients' Adherence. TANAFFOS 2021; 20:209-220. [PMID: 35382079 PMCID: PMC8978036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 02/13/2021] [Indexed: 12/04/2022]
Abstract
BACKGROUND The current systematic review aimed to determine the effect of telemedicine services on adherence in patients with chronic obstructive pulmonary disease (COPD) and to describe the type of adherence and applied devices and modules. MATERIALS AND METHODS We reviewed PubMed, Scopus, Web of Science, and Embase databases to identify relevant studies from the time of inception of these databases to March 10, 2019, using three groups of keywords. The first group comprised words describing COPD, the second group included words describing types of telemedicine interventions, and the third group contained words describing adherence. The reference list of identified articles was also hand-searched to retrieve possibly relevant articles. RESULTS In total 21 articles were included, in which 13 reported a positive effect for telemedicine on patients' adherence. Adherence to treatment was classified under six categories. The highest frequency belongs to the adherence to performing exercises and participation in training sessions, using the system, using devices, measuring (like blood pressure, oxygen saturation, heart rate, weight, temperature, sputum volume) and reporting symptoms and the results of measurements, completing tasks, and medication. CONCLUSION This study demonstrated the effectiveness of telemedicine services on adherence to treatment plans in patients with COPD. The following factors contribute to the effectiveness of telemedicine services: patient support by healthcare professionals and easy access to them, uninterrupted execution of telemedicine programs, follow-up and supervision of providers, creating and maintaining motivation in patients, and provision of different self-management modules.
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Affiliation(s)
- Azam Sabahi
- Department of Health Information Technology, Ferdows School of Health and Allied Medical Sciences, Birjand University of Medical Sciences, South Khorasan, Iran
| | - Azamossadat Hosseini
- Department of Health Information Technology and Management, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran,,Correspondence to: Hosseini A, Address: Department of Health Information Technology and Management, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran, Email address:
| | - Hasan Emami
- Department of Health Information Technology and Management, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sohrab Almasi
- Department of Health Information Technology and Management, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Shrestha R, Shrestha AP, Sonnenberg T, Mistry J, Shrestha R, MacKinney T. Needs Assessment and Identification of the Multifaceted COPD Care Bundle in the Emergency Department of a Tertiary Hospital in Nepal. Int J Chron Obstruct Pulmon Dis 2021; 16:125-136. [PMID: 33519197 PMCID: PMC7837591 DOI: 10.2147/copd.s285744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 12/30/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose Acute care of patients with exacerbation of chronic obstructive pulmonary disease (AECOPD) in the emergency department (ED) is crucial, however not studied extensively in Nepal. The purpose of this study is to identify the opportunities for succinct measures to optimize the AECOPD care in ED with a multifaceted bundle care approach in a resource-limited setting. Methods We conducted a prospective cross-sectional observational study as an initial baseline stage of the quality improvement project. Demographic data, clinical characteristics, the current diagnosis and treatment performances of AECOPD were recorded. The primary outcome measures were 30-day ED revisit and near-fatal events which were compared with other variables and performances with binary and logistic regression. The multidisciplinary team performed the root cause and Pareto analysis to identify the potential gaps in the AECOPD care. Results The AECOPD performance measures were suboptimal. Written AECOPD emergency management clinical guidelines and advice regarding pulmonary rehabilitation were absent. Among the 249 AECOPD encounters, bilevel positive-airway pressure ventilation was started in 6.4%. At discharge, 11.8% and 39.7% were given oral steroids and antibiotics respectively; 2.2% were advised vaccination. Near-fatal events and 30-day revisit occurred in 19% and 38.2% of the encounters respectively. Those who required domiciliary oxygen had significantly higher 30-day revisits (OR=2.5; 95% CI=1.43-4.4; P value =0.001) as did those who were previously admitted (OR=1.98; 95% CI 1.11-3.59; P value =0.022). Those who had a 30-day revisit had increased near-fatal events (OR=2.86; 95% CI=1.362-6.18; P value =0.006). The opportunities for improving the ED care were identified and feasible interventions and their indicators are summarized for future implementation. Conclusion The current COPD performance measures were suboptimal with high 30-day revisit and near-fatal outcomes. We suggest the urgent implementation of the enlisted feasible bundles-care involving multifaceted team and protocol-based management plans for AECOPD in a busy resource-limited ED.
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Affiliation(s)
- Roshana Shrestha
- Department of General Practice and Emergency Medicine, Kathmandu University School of Medical Sciences, Dhulikhel, Kavrepalanchok, Nepal
| | - Anmol Purna Shrestha
- Department of General Practice and Emergency Medicine, Kathmandu University School of Medical Sciences, Dhulikhel, Kavrepalanchok, Nepal
| | - Taylor Sonnenberg
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Janki Mistry
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Rajeev Shrestha
- Department of Pharmacology, Kathmandu University School of Medical Sciences, Dhulikhel, Kavrepalanchok, Nepal.,Nepal Pharmacovigilance Unit/Research & Development Division, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavrepalanchok, Nepal
| | - Theodore MacKinney
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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Abstract
Patients with chronic obstructive pulmonary disease (COPD) who are rehospitalized following hospitalization for an exacerbation of COPD are at higher risk of mortality and poor health outcomes. Approximately 20% of patients who are discharged from the hospital following an exacerbation of COPD are readmitted within 30 days. At a home healthcare agency in southeastern United States, 36.4% of patients admitted to the agency with a primary or secondary diagnosis of COPD between August 2018 and January 2019 were rehospitalized within 30 days of admission. A quality improvement project was conducted between January 2019 and July 2019. This project involved implementation of a COPD self-management care plan packet provided by home healthcare nurses to patients with a primary or secondary diagnosis of COPD. The 30-day rehospitalizations for patients with COPD decreased from 36.4% preintervention to 15.4% postintervention. The number of patients receiving timely follow-up with their provider increased from 79% preintervention to 88% postintervention, and COPD medication reconciliation at admission improved from 79% preintervention to 84% postintervention. The generalizability of these results is limited due to a small sample size and inconsistencies in intervention implementation.
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13
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Westbroek LF, Klijnsma M, Salomé P, Sekhuis LM, Rolink E, Korsmit E, Kerstjens HAM. Reducing the Number of Hospitalization Days for COPD: Setting up a Transmural-Care Pathway. Int J Chron Obstruct Pulmon Dis 2020; 15:2367-2377. [PMID: 33061354 PMCID: PMC7533231 DOI: 10.2147/copd.s242914] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 07/09/2020] [Indexed: 11/27/2022] Open
Abstract
Background Many patients with chronic obstructive pulmonary disease (COPD) experience exacerbations of symptoms, leading to a large burden on patients and the health system and costs to society. To address this burden, a 25% reduction in number of hospitalization days for COPD exacerbations was recently declared a national goal in the Netherlands, to be achieved in 5 years. Methods A national care pathway was designed following an established managed clinical pathway setup, which involved prior national surveys and the identification of ten key elements. The concept was discussed, made locally applicable, and finally tested in eight regions containing eleven hospitals and surrounding primary-care groups in a prospective cohort study. All patients were followed for 1 year, starting at hospitalization. Results In total, 752 patients gave informed consent and participated (mean age 70 years, 58% female). Of these, 120 (16%) died within a year. The median length of index hospitalization was 5 days, and 43% had at least one rehospitalization within 1 year (range 0–8). There was a 19.4% reduction in number of total hospitalization days, without a decrease in health-related quality of life or perceived quality of care. Elements that contributed significantly to the reduction were contact in the first week after hospitalization, and during the year of follow-up pharmacological and nonpharmacological smoking-cessation guidance, checks on inhalation technique, and discussion of lung-attack plan. Discussion With concerted action between patients and health workers in the hospital and in the community, a large reduction in number of hospitalization days can be achieved. The program was quite demanding for both patients and health workers. In our subsequent national implementation plan after this pilot study, we have named the major contributors to success and advocate the stepwise introduction of the elements in light of feasibility.
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Affiliation(s)
- Lotte F Westbroek
- Department of Pulmonary Diseases, University of Groningen, and University Medical Center Groningen, Groningen Research Institute for Asthma and COPD GRIAC, Groningen, The Netherlands
| | - Margot Klijnsma
- Department of Pulmonary Diseases, University of Groningen, and University Medical Center Groningen, Groningen Research Institute for Asthma and COPD GRIAC, Groningen, The Netherlands
| | - Philippe Salomé
- General practitioner, private practice, IJsselstein, The Netherlands
| | - Lidewij M Sekhuis
- Department of Pulmonary Diseases, University of Groningen, and University Medical Center Groningen, Groningen Research Institute for Asthma and COPD GRIAC, Groningen, The Netherlands.,Lung Alliance Netherlands (LAN), Amersfoort, The Netherlands
| | - Emiel Rolink
- Lung Alliance Netherlands (LAN), Amersfoort, The Netherlands
| | - Erny Korsmit
- Bravis Hospital, The Netherlands and Senior Advisor Healthcare Networking at Korsmit Zorgadvies, Bergen Op Zoom, The Netherlands
| | - Huib A M Kerstjens
- Department of Pulmonary Diseases, University of Groningen, and University Medical Center Groningen, Groningen Research Institute for Asthma and COPD GRIAC, Groningen, The Netherlands.,Lung Alliance Netherlands (LAN), Amersfoort, The Netherlands
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Axson EL, Ragutheeswaran K, Sundaram V, Bloom CI, Bottle A, Cowie MR, Quint JK. Hospitalisation and mortality in patients with comorbid COPD and heart failure: a systematic review and meta-analysis. Respir Res 2020; 21:54. [PMID: 32059680 PMCID: PMC7023777 DOI: 10.1186/s12931-020-1312-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 02/04/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Discrepancy exists amongst studies investigating the effect of comorbid heart failure (HF) on the morbidity and mortality of chronic obstructive pulmonary disease (COPD) patients. METHODS MEDLINE and Embase were searched using a pre-specified search strategy for studies comparing hospitalisation, rehospitalisation, and mortality of COPD patients with and without HF. Studies must have reported crude and/or adjusted rate ratios, risk ratios, odds ratios (OR), or hazard ratios (HR). RESULTS Twenty-eight publications, reporting 55 effect estimates, were identified that compared COPD patients with HF with those without HF. One study reported on all-cause hospitalisation (1 rate ratio). Two studies reported on COPD-related hospitalisation (1 rate ratio, 2 OR). One study reported on COPD- or cardiovascular-related hospitalisation (4 HR). One study reported on 90-day all-cause rehospitalisation (1 risk ratio). One study reported on 3-year all-cause rehospitalisation (2 HR). Four studies reported on 30-day COPD-related rehospitalisation (1 risk ratio; 5 OR). Two studies reported on 1-year COPD-related rehospitalisation (1 risk ratio; 1 HR). One study reported on 3-year COPD-related rehospitalisation (2 HR). Eighteen studies reported on all-cause mortality (1 risk ratio; 4 OR; 24 HR). Five studies reported on all-cause inpatient mortality (1 risk ratio; 4 OR). Meta-analyses of hospitalisation and rehospitalisation were not possible due to insufficient data for all individual effect measures. Meta-analysis of studies requiring spirometry for the diagnosis of COPD found that risk of all-cause mortality was 1.61 (pooled HR; 95%CI: 1.38, 1.83) higher in patients with HF than in those without HF. CONCLUSIONS In this systematic review, we investigated the effect of HF comorbidity on hospitalisation and mortality of COPD patients. There is substantial evidence that HF comorbidity increases COPD-related rehospitalisation and all-cause mortality of COPD patients. The effect of HF comorbidity may differ depending on COPD phenotype, HF type, or HF severity and should be the topic of future research.
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Affiliation(s)
- Eleanor L Axson
- National Heart and Lung Institute, Imperial College London, G05 Emmanuel Kaye Building, Manresa Road, London, SW3 6LR, UK.
| | - Kishan Ragutheeswaran
- National Heart and Lung Institute, Imperial College London, G05 Emmanuel Kaye Building, Manresa Road, London, SW3 6LR, UK
| | - Varun Sundaram
- National Heart and Lung Institute, Imperial College London, G05 Emmanuel Kaye Building, Manresa Road, London, SW3 6LR, UK
| | - Chloe I Bloom
- National Heart and Lung Institute, Imperial College London, G05 Emmanuel Kaye Building, Manresa Road, London, SW3 6LR, UK
| | - Alex Bottle
- Dr Foster Unit, Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Martin R Cowie
- National Heart and Lung Institute, Imperial College London, G05 Emmanuel Kaye Building, Manresa Road, London, SW3 6LR, UK
| | - Jennifer K Quint
- National Heart and Lung Institute, Imperial College London, G05 Emmanuel Kaye Building, Manresa Road, London, SW3 6LR, UK
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Lin SY, Xue H, Deng Y, Chukmaitov A. Multi-morbidities are Not a Driving Factor for an Increase of COPD-Related 30-Day Readmission Risk. Int J Chron Obstruct Pulmon Dis 2020; 15:143-154. [PMID: 32021153 PMCID: PMC6970247 DOI: 10.2147/copd.s230072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 12/19/2019] [Indexed: 12/04/2022] Open
Abstract
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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Affiliation(s)
- Shuo-Yu Lin
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Hong Xue
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Yangyang Deng
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Askar Chukmaitov
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
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Barnett T, Jenkins A, Bouldin A, Crumby M, Morgan AK, Warren ML. Assessing Quality of Pharmacist-Led Education for Patients with COPD Using the Lung Information Needs Questionnaire: A Pilot Study. Innov Pharm 2019; 10:10.24926/iip.v10i2.1515. [PMID: 34007545 PMCID: PMC7592861 DOI: 10.24926/iip.v10i2.1515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Transitioning a patient from the hospital to home is an area of vulnerability for patients with Chronic Obstructive Pulmonary Disease (COPD). Patients with COPD frequently readmit as they often do not understand their disease state, medications or when to seek medical attention. OBJECTIVES The objective of this study is to determine the impact that pharmacist-led education has on a patient's understanding of their disease state by assessing the results of the Lung Information Needs Questionnaire (LINQ). METHODS This study uses a quasi-experimental design to formally assess pharmacist-led education provided to patients with COPD using the LINQ. The LINQ was used to assess knowledge of the disease state and medications before and after receiving education on disease state management, smoking cessation and proper medication use. RESULTS A total of 17 patients completed the LINQ. The survey results showed a statistically significant improvement in patient understanding in 4 of the 6 targeted areas. CONCLUSION Results from the formal assessment using the LINQ suggest that pharmacist-lead education for COPD patients is beneficial and reliable. This study presents a continued need for patient education and research in this high-risk patient population.
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Gershon AS, Thiruchelvam D, Aaron S, Stanbrook M, Vozoris N, Tan WC, Cho E, To T. Socioeconomic status (SES) and 30-day hospital readmissions for chronic obstructive pulmonary (COPD) disease: A population-based cohort study. PLoS One 2019; 14:e0216741. [PMID: 31112573 PMCID: PMC6528994 DOI: 10.1371/journal.pone.0216741] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 04/26/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Patients with chronic obstructive pulmonary disease (COPD) are more likely to be readmitted than patients with other chronic medical conditions, yet knowledge regarding such readmissions is limited. We aimed to determine factors associated with readmission within 30 days of a COPD hospitalization or death with an emphasis on examining aspects of socioeconomic status and specific comorbidities. METHODS A population-based cohort study was conducted using health administrative data from Ontario, Canada. All hospitalizations for COPD between 2004 and 2014 were considered. The primary exposures were socioeconomic status as measured by residential instability (an ecologic variable), and comorbidities such as cardiovascular disease and cancer. Other domains of socioeconomic status were considered as secondary exposures. Logistic regression with generalized estimating equations was used to examine the effect of exposures, adjusting for other patient factors, on 30-day readmission or death. RESULTS There were 126,013 patients contributing to 252,756 index COPD hospitalizations from 168 Ontario hospitals. Of these hospitalizations, 19.4% resulted in a readmission and 2.8% resulted in death within 30 days. After adjusting for other factors, readmissions or death were modestly more likely among people with the highest residential instability compared to the lowest (OR 1.05, 95% CI 1.01-1.09). Comorbidities such as cardiovascular disease and cancer, as well as other aspects of low socioeconomic status also increased readmission or death risk. INTERPRETATION Socioeconomic status, measured in various ways, and many comorbidities predict 30-day readmission or death in patients hospitalized for COPD. Strategies that address these factors may help reduce readmissions and death.
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Affiliation(s)
- Andrea S. Gershon
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- * E-mail:
| | - Deva Thiruchelvam
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Shawn Aaron
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Matthew Stanbrook
- Asthma & Airway Centre, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Nicholas Vozoris
- Department of Medicine, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Wan C. Tan
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Eunice Cho
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Teresa To
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, Ontario, Canada
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Insights about the economic impact of chronic obstructive pulmonary disease readmissions post implementation of the hospital readmission reduction program. Curr Opin Pulm Med 2019; 24:138-146. [PMID: 29210750 DOI: 10.1097/mcp.0000000000000454] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW Chronic obstructive pulmonary disease (COPD) affects over 12 million adults in the United States and is the third leading cause of 30-day readmissions. COPD is costly with almost $50 billion in direct costs annually. Total COPD costs can be up to double the identified direct costs because of comorbid disease and numerous indirect costs such as absenteeism. Acute exacerbations of COPD (AECOPD) are responsible for up to 70% of COPD-related healthcare costs; hospital readmissions alone account for over $15 billion annually. In this review, we aim to describe insights about the economic impact of COPD readmissions based on articles published over the last 18 months. RECENT FINDINGS Interventions aimed at reducing readmission, particularly those using interdisciplinary teams with bundled care interventions, were uniformly successful at improving the quality of care provided and demonstrating improved process measures. However, success at reducing readmissions and cost savings based on these interventions varied across the studies. SUMMARY The literature to date points to factors and conditions that may place patients at higher risk of readmissions and may lead to higher costs. Interventions aimed at reducing readmissions after index admissions for AECOPD have demonstrated variable results. Most interventions did not reflect cost-based analyses.
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Reply: Looking for Predictors of Early Readmission in Chronic Obstructive Pulmonary Disease: Every Effort Is Required. Ann Am Thorac Soc 2018; 15:1367. [DOI: 10.1513/annalsats.201808-526le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Jacobs DM, Noyes K, Zhao J, Gibson W, Murphy TF, Sethi S, Ochs-Balcom HM. Early Hospital Readmissions after an Acute Exacerbation of Chronic Obstructive Pulmonary Disease in the Nationwide Readmissions Database. Ann Am Thorac Soc 2018; 15:837-845. [PMID: 29611719 PMCID: PMC6207114 DOI: 10.1513/annalsats.201712-913oc] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Accepted: 03/27/2018] [Indexed: 01/22/2023] Open
Abstract
RATIONALE Understanding the causes and factors related to readmission for an acute exacerbation of chronic obstructive pulmonary disease (AECOPD) within a nationwide database including all payers and ages can provide valuable input for the development of generalizable readmission reduction strategies. OBJECTIVES To determine the rates, causes, and predictors for early (3-, 7-, and 30-d) readmission in patients hospitalized with AECOPD in the United States using the Nationwide Readmission Database after the initiation of the Hospital Readmissions Reduction Program, but before its expansion to COPD. METHODS We conducted an analysis of the Nationwide Readmission Database from 2013 to 2014. Index admissions and readmissions for an AECOPD were defined consistent with Hospital Readmissions Reduction Program guidelines. We investigated the percentage of 30-day readmissions occurring each day after discharge and the most common readmission diagnoses at different time periods after hospitalization. The relationship between predictors (categorized as patient, clinical, and hospital factors) and early readmission were evaluated using a hierarchical two-level logistic model. To examine covariate effects on early-day readmission, predictors for 3-, 7-, and 30-day readmissions were modeled separately. RESULTS There were 202,300 30-day readmissions after 1,055,830 index AECOPD admissions, a rate of 19.2%. The highest readmission rates (4.2-5.5%) were within the first 72 hours of discharge, and 58% of readmissions were within the first 15 days. Respiratory-based diseases were the most common reasons for readmission (52.4%), and COPD was the most common diagnosis (28.4%). Readmission diagnoses were similar at different time periods after discharge. Early readmission was associated with patient (Medicaid payer status, lower household income, and higher comorbidity burden) and clinical factors (longer length of stay and discharge to a skilled nursing facility). Predictors did not vary substantially by time of readmission after discharge within the 30-day window. CONCLUSIONS Thirty-day readmissions after an AECOPD remain a major healthcare burden, and are characterized by a similar spectrum of readmission diagnoses. Predictors associated with readmission include both patient and clinical factors. Development of a COPD-specific risk stratification algorithm based on these factors may be necessary to better predict patients with AECOPD at high risk of early readmission.
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Affiliation(s)
- David M. Jacobs
- Department of Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences
| | - Katia Noyes
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions
| | - Jiwei Zhao
- Department of Biostatistics, School of Public Health and Health Professions, and
| | - Walter Gibson
- Department of Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences
| | - Timothy F. Murphy
- Department of Medicine, Clinical and Translational Research Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Sanjay Sethi
- Department of Medicine, Clinical and Translational Research Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Heather M. Ochs-Balcom
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions
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21
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Burkes RM, Gassett AJ, Ceppe AS, Anderson W, O'Neal WK, Woodruff PG, Krishnan JA, Barr RG, Han MK, Martinez FJ, Comellas AP, Lambert AA, Kaufman JD, Dransfield MT, Wells JM, Kanner RE, Paine R, Bleecker ER, Paulin LM, Hansel NN, Drummond MB. Rural Residence and Chronic Obstructive Pulmonary Disease Exacerbations. Analysis of the SPIROMICS Cohort. Ann Am Thorac Soc 2018; 15:808-816. [PMID: 29584453 PMCID: PMC6207115 DOI: 10.1513/annalsats.201710-837oc] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 03/06/2018] [Indexed: 12/13/2022] Open
Abstract
Rationale: Rural residence is associated with poor outcomes in several chronic diseases. The association between rural residence and chronic obstructive pulmonary disease (COPD) exacerbations remains unclear.Objectives: In this work, we sought to determine the independent association between rural residence and COPD-related outcomes, including COPD exacerbations, airflow obstruction, and symptom burden.Methods: A total of 1,684 SPIROMICS (Subpopulations and Intermediate Outcome Measures in COPD Study) participants with forced expiratory volume in 1 second/forced vital capacity < 0.70 had geocoding-defined rural-urban residence status determined (N = 204 rural and N = 1,480 urban). Univariate and multivariate logistic and negative binomial regressions were performed to assess the independent association between rurality and COPD outcomes, including exacerbations, lung function, and symptom burden. The primary exposure of interest was rural residence, determined by geocoding of the home address to the block level at the time of study enrollment. Additional covariates of interest included demographic and clinical characteristics, occupation, and occupational exposures. The primary outcome measures were exacerbations determined over a 1-year course after enrollment by quarterly telephone calls and at an annual research clinic visit. The odds ratio (OR) and incidence rate ratio (IRR) of exacerbations that required treatment with medications, including steroids or antibiotics (total exacerbations), and exacerbations leading to hospitalization (severe exacerbations) were determined after adjusting for relevant covariates.Results: Rural residence was independently associated with a 70% increase in the odds of total exacerbations (OR, 1.70 [95% confidence interval (CI), 1.13-2.56]; P = 0.012) and a 46% higher incidence rate of total exacerbations (IRR 1.46 [95% CI, 1.02-2.10]; P = 0.039). There was no association between rural residence and severe exacerbations. Agricultural occupation was independently associated with increased odds and incidence of total and severe exacerbations. Inclusion of agricultural occupation in the analysis attenuated the association between rural residence and the odds and incidence rate of total exacerbations (OR, 1.52 [95% CI, 1.00-2.32]; P = 0.05 and IRR 1.39 [95% CI, 0.97-1.99]; P = 0.07). There was no difference in symptoms or airflow obstruction between rural and urban participants.Conclusions: Rural residence is independently associated with increased odds and incidence of total, but not severe, COPD exacerbations. These associations are not fully explained by agriculture-related exposures, highlighting the need for future research into potential mechanisms of the increased risk of COPD exacerbations in the rural population.
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Affiliation(s)
| | - Amanda J Gassett
- Department of Environmental and Occupational Health Sciences, School of Public Health, and
| | - Agathe S Ceppe
- Marsico Lung Institute/Cystic Fibrosis Research Center, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Wayne Anderson
- Marsico Lung Institute/Cystic Fibrosis Research Center, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Wanda K O'Neal
- Marsico Lung Institute/Cystic Fibrosis Research Center, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Prescott G Woodruff
- Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine and Cardiovascular Research Institute, University of California San Francisco, School of Medicine, San Francisco, California
| | - Jerry A Krishnan
- Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois, Chicago, Illinois
| | - R Graham Barr
- Department of Medicine, Columbia University Medical Center, New York, New York
| | - MeiLan K Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, Ann Arbor, Michigan
| | - Fernando J Martinez
- Department of Medicine, Weill Cornell Medical College, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York
| | | | - Allison A Lambert
- Division of Pulmonary and Critical Care, University of Washington, Seattle, Washington
| | - Joel D Kaufman
- Department of Environmental and Occupational Health Sciences, School of Public Health, and
| | - Mark T Dransfield
- Division of Pulmonary and Critical Care, University of Alabama at Birmingham, Birmingham, Alabama
| | - J Michael Wells
- Division of Pulmonary and Critical Care, University of Alabama at Birmingham, Birmingham, Alabama
| | - Richard E Kanner
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Robert Paine
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Utah, Salt Lake City, Utah
| | - Eugene R Bleecker
- Division of Pulmonary, Critical Care, Allergy and Immunologic Diseases, Wake Forest University, Winston-Salem, North Carolina; and
| | - Laura M Paulin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Nadia N Hansel
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
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22
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Sobotka LA, Modi RM, Vijayaraman A, Hanje AJ, Michaels AJ, Conteh LF, Hinton A, El-Hinnawi A, Mumtaz K. Paracentesis in cirrhotics is associated with increased risk of 30-day readmission. World J Hepatol 2018; 10:425-432. [PMID: 29988878 PMCID: PMC6033715 DOI: 10.4254/wjh.v10.i6.425] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 03/13/2018] [Accepted: 04/11/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To determine the readmission rate, its reasons, predictors, and cost of 30-d readmission in patients with cirrhosis and ascites. METHODS A retrospective analysis of the nationwide readmission database (NRD) was performed during the calendar year 2013. All adults cirrhotics with a diagnosis of ascites, spontaneous bacterial peritonitis, or hepatic encephalopathy were identified by ICD-9 codes. Multivariate analysis was performed to assess predictors of 30-d readmission and cost of readmission. RESULTS Of the 59597 patients included in this study, 18319 (31%) were readmitted within 30 d. Majority (58%) of readmissions were for liver related reasons. Paracentesis was performed in 29832 (50%) patients on index admission. Independent predictors of 30-d readmission included age < 40 (OR: 1.39; CI: 1.19-1.64), age 40-64 (OR: 1.19; CI: 1.09-1.30), Medicaid (OR: 1.21; CI: 1.04-1.41) and Medicare coverage (OR: 1.13; CI: 1.02-1.26), > 3 Elixhauser comorbidity (OR: 1.13; CI: 1.05-1.22), nonalcoholic cirrhosis (OR: 1.16; CI: 1.10-1.23), paracentesis on index admission (OR: 1.28; CI: 1.21-1.36) and having hepatocellular carcinoma (OR: 1.21; CI: 1.05; 1.39). Cost of index admission was similar in patients readmitted and not readmitted (P-value: 0.34); however cost of care was significantly more on 30 d readmission ($30959 ± 762) as compared to index admission ($12403 ± 378), P-value: < 0.001. CONCLUSION Cirrhotic patients with ascites have a 33% chance of readmission within 30-d. Younger patients, with public insurance, nonalcoholic cirrhosis and increased comorbidity who underwent paracentesis are at increased risk of readmission. Risk factors for unplanned readmission should be targeted given these patients have higher healthcare utilization.
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Affiliation(s)
- Lindsay A Sobotka
- Department of Internal Medicine, the Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
| | - Rohan M Modi
- Department of Internal Medicine, the Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
| | - Akshay Vijayaraman
- Department of Internal Medicine, the Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
| | - A James Hanje
- Division of Gastroenterology, Hepatology and Nutrition, the Ohio State Wexner Medical Center, Columbus, OH 43210, United States
| | - Anthony J Michaels
- Division of Gastroenterology, Hepatology and Nutrition, the Ohio State Wexner Medical Center, Columbus, OH 43210, United States
| | - Lanla F Conteh
- Division of Gastroenterology, Hepatology and Nutrition, the Ohio State Wexner Medical Center, Columbus, OH 43210, United States
| | - Alice Hinton
- Division of Biostatistics, College of Public Health, the Ohio State University, Columbus, OH 43210, United States
| | - Ashraf El-Hinnawi
- Department of Surgery, the Ohio State Wexner Medical Center, Columbus, OH 43210, United States
| | - Khalid Mumtaz
- Division of Gastroenterology, Hepatology and Nutrition, the Ohio State Wexner Medical Center, Columbus, OH 43210, United States.
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23
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Witry M, Comellas A, Simmering J, Polgreen P. The Association Between Technology Use and Health Status in a Chronic Obstructive Pulmonary Disease Cohort: Multi-Method Study. J Med Internet Res 2018; 20:e125. [PMID: 29610113 PMCID: PMC5902698 DOI: 10.2196/jmir.9382] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 01/03/2018] [Accepted: 02/03/2018] [Indexed: 11/13/2022] Open
Abstract
Background Telemedicine and electronic health (eHealth) interventions have been proposed to improve management of chronic obstructive pulmonary disease (COPD) for patients between traditional clinic and hospital visits to reduce complications. However, the effectiveness of such interventions may depend on patients’ comfort with technology. Objective The aim was to describe the relationship between patient demographics and COPD disease severity and the use of communication-related technology. Methods We administered a structured survey about the use of communication technologies to a cohort of persons in the COPDGene study at one midwestern hospital in the United States. Survey results were combined with clinical and demographic data previously collected as part of the cohort study. A subsample of patients also completed eHealth simulation tasks. We used logistic or linear regression to determine the relationship between patient demographics and COPD disease severity and reported use of communication-related technology and the results from our simulated eHealth-related tasks. Results A total of 686 patients completed the survey and 100 participated in the eHealth simulation. Overall, those who reported using communication technology were younger (P=.005) and had higher incomes (P=.03). Men appeared less likely to engage in text messaging (P<.001) than women. Patients who spent more time on tasks in the eHealth simulation had greater odds of a COPD Assessment Test score >10 (P=.02) and walked shorter distances in their 6-minute walk tests (P=.003) than those who took less time. Conclusions Older patients, patients with lower incomes, and less healthy patients were less likely to report using communication technology, and they did not perform as well on our simulated eHealth tasks. Thus, eHealth-based interventions may not be as effective in these populations, and additional training in communication technology may be needed.
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Affiliation(s)
- Matthew Witry
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City, IA, United States
| | - Alejandro Comellas
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, United States
| | - Jacob Simmering
- Signal Center for Health Innovation, University of Iowa, Iowa City, IA, United States
| | - Philip Polgreen
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, United States
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24
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Reducing COPD readmissions through predictive modeling and incentive-based interventions. Health Care Manag Sci 2017; 22:121-139. [PMID: 29177758 DOI: 10.1007/s10729-017-9426-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 11/09/2017] [Indexed: 10/18/2022]
Abstract
This paper introduces a case study at a community hospital to develop a predictive model to quantify readmission risks for patients with chronic obstructive pulmonary disease (COPD), and use it to support decision making for appropriate incentive-based interventions. Data collected from the community hospital's database are analyzed to identify risk factors and a logistic regression model is developed to predict the readmission risk within 30 days post-discharge of an individual COPD patient. By targeting on the high-risk patients, we investigate the implementability of the incentive policy which encourages patients to take interventions and helps them to overcome the compliance barrier. Specifically, the conditions and scenarios are identified for either achieving the desired readmission rate while minimizing the total cost, or reaching the lowest readmission rate under incentive budget constraint. Currently, such models are under consideration for a pilot study at the community hospital.
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