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Topics in Practice ManagementReducing COPD Readmissions: Strategies for the Pulmonologist to Improve Outcomes
Section snippets
Hospital Readmissions and AECOPD
According to the Centers for Medicare & Medicaid Services website Hospital Compare, the current national rate of readmission within 30 days for patients with COPD is 19.6%, with the majority of hospitals falling in the range of 17.3% to 21.2%.6 This readmission rate has been relatively stable over the last decade.7 Of those patients who are readmitted, > 50% of readmissions occur within the first 14 days following discharge from the hospital.8 Most readmissions involve respiratory-related
Interventions Targeted at Reducing Readmissions
Although many approaches have been systematically evaluated to improve outcomes, few interventions have consistently been associated with reductions in readmissions for patients with AECOPD. Interventions, including inpatient pharmacist education and inhaler dispensing prior to discharge,13, 14 early outpatient hospital follow-up,15, 16, 17 supported and unsupported self-management programs,18, 19 home telemedicine management,20, 21, 22 and noninvasive ventilation,23, 24, 25 have all met with
In the Hospital and Transition to Home
How can the pulmonologist help reduce readmissions, starting with the inpatient admission? Part of our system’s multidisciplinary approach includes a mandatory pulmonary consultation for patients deemed to be at moderate to high risk of readmission. Our rationale is that these patients should benefit from specialist intervention. Based on our preliminary observations and limited peer-reviewed literature, it is not clear that mandatory consultation for all patients with COPD exacerbations is of
Early Hospital Follow-up
As mentioned previously, most readmissions following an index admission for AECOPD occur within 14 days’ postdischarge. Most of these readmissions are not related to a new COPD exacerbation, and there are few consistent predictors to help guide clinicians.3, 9, 10, 11, 33 Several programs targeting different disease states, including COPD, have reported some improvements with readmissions with the use of early outpatient hospital follow-up.15, 16, 17, 34 For this approach to be successful and
Other Interventions Requiring More Research
The role of predictive modeling tools to help providers better identify patients at increased risk of readmission and allow them to allocate resources appropriately is not clear at this time.50 In addition, the impact of admitting patients with COPD to their own specialized units with more care management resources in the hospital setting is unknown. Finally, the role for hospital at-home programs is also unclear.
Conclusions
Strategies to reduce readmissions for all patients, including those with AECOPD, will continue to be a focus of payers, systems, clinicians, and patients. In a time when providers and caretakers are being asked to do more with less, the ultimate goal of improving patient outcomes and experiences while reducing cost may be difficult. Thus, choosing the right interventions that will utilize financial and human resources in a cost-effective manner will be of key importance. Larger systems with
Acknowledgments
Financial/nonfinancial disclosures: None declared.
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