Study Evaluates Impact of Care Management Programs on COPD Readmission Rates

One of the leading causes of hospitalization in the United States is due to acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Due to its prevalence, many healthcare organizations and government agencies aim to reduce its frequency due to the heavy financial and health burden. A recent study aimed to investigate the clinical and psychosocial risk factors that are associated with readmissions for COPD exacerbations among patients.

The study assessed the clinical and psychosocial risk factors associated with readmissions for COPD exacerbations, specifically among patients of an academic community hospital which implemented a comprehensive care management program (CCMP). The study involved an analysis of patients admitted to Danbury Hospital, where a COPD readmission reduction initiative was implemented.

“The Agency for Healthcare Research and Quality estimates that 1 out of every 5 patients over the age of 40 who have been hospitalized in the past decade carries a diagnosis of chronic obstructive pulmonary disease (COPD),” noted the study. “Given its prevalence in hospitalized patients, COPD and its acute exacerbation pose a heavy financial burden in health care.”

Exacerbation of COPD was defined by the study as increased cough, increased sputum, change in sputum color, or increased dyspnea in a patient with COPD. Data was collected on patients with a diagnosis of AECOPD, including an assessment of their clinical comorbidities, such as pneumonia, presence of musculoskeletal disorders, cognitive disorders, anxiety disorders, substance abuse, and smoking status. Psychosocial risk factors were also evaluated, including anxiety, home safety, and access to transportation.

Throughout the study period, between September 2014 and September 2015, there were a total of 366 admissions for COPD exacerbations among 291 patients. Of these patients, 272 met the criteria to be included in the study. The analysis revealed that 20 patients were readmitted within 30 days of their index hospitalization, and 252 patients were not readmitted. Of those readmitted, the mean age was 74.3 years, while the mean age was 73.1 years among those who has a single admission.

Patients who were readmitted were significantly more likely to have pneumonia at readmission compared with those who were not readmitted (30% versus 13.1%, P < 0.05). No statistically significant difference was seen between the 2 groups with respect to any other comorbidities. Patients who were readmitted within 30 days were significantly more likely than those who were not readmitted to have safety issues at home (80% versus 39.3%, P <0.001), anxiety (60% versus 29.8%, P <0.01) and lack of transportation (35% versus 15.5%, P <0.05).

The researchers found no statistically significant differences between those who were readmitted and those who were not in respect to age, smoking status, gender, or BMI.

Following the 1-year post implementation of the CCMP, the annual readmission rate decreased from 21.5% to 13.6%.

“From a community hospital that has successfully reduced readmissions for AECOPD after implementation of our CCMP, we speculate that a CCMP can reduce readmission rates with careful execution of a program that includes optimization of in-hospital care, better coordination of pre- and post-discharge care, attention to social variables, a system to better identify patient problems after discharge, and an office setup that can accommodate same day sick visits,” concluded the study.

Reference

Euceda G, Kong WT, Kapoor A, Dilauro P, Ogunnaike R, Chronakos J. The effects of a comprehensive care management program on readmission rates after acute exacerbation of COPD at a community-based academic hospital. In press. Chronic Obstr Pulm Dis. 2018; 5(3): doi: 10.15326/jcopdf.5.3.2017.0177