A retrospective analysis to identify predictors of COPD-related rehospitalization

Roberts, Melissa H.; Clerisme-Beaty, Emmanuelle; Kozma, Chris M; Paris, A. M. I.; Slaton, Terra; Mapel, Douglas W.

doi:10.1186/s12890-016-0231-3

Cited by 31 publications

(33 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We have observed a reduction in readmission rates at 30, 60, and 90 days for both all-cause and COPD-related admissions. However, our failure to show a benefit in COPD-related readmission at 30 days admissions is consistent with other studies that have shown a similar readmission rate at this time point 28,29. One potential factor is that as we reduce the LOS, there is a risk of premature discharge of subjects who even with intensive community supports fail to transition to a stable clinical state at home.…”

Section: Discussionsupporting

confidence: 89%

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

Alshabanat¹,

Otterstatter²,

Sin³

et al. 2017

COPD

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionsupporting

confidence: 89%

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

Alshabanat¹,

Otterstatter²,

Sin³

et al. 2017

COPD

View full text Add to dashboard Cite

show abstract

“…Patients who received physician follow-up within 30 days of discharge were significantly less likely to be readmitted (OR 0.7; P <0.001) 16. Roberts et al (2016) conducted a study involving 3,612 COPD admissions, and reported that comorbidities and prior hospitalizations were the strongest predictors of early COPD-related rehospitalizations (<30 days), while respiratory-related therapies including the use of steroids (OR 1.62, P =0.007) and nebulizers (OR 1.65, P =0.007) during the index admission were the strongest predictor of late COPD-related re-hospitalizations (>30 days), but not early rehospitalizations 17. Similarly, several studies have indicated that patients prescribed steroids and antibiotics were less likely to be readmitted 18–21…”

Section: Discussionmentioning

confidence: 99%

Readmission After COPD Exacerbation Scale: determining 30-day readmission risk for COPD patients

Lau

Siracuse

Chamberlain

2017

COPD

View full text Add to dashboard Cite

BackgroundCOPD affects over 13 million Americans, and accounts for over half a million hospitalizations annually. The Hospital Readmission Reduction Program, established by the Affordable Care Act requires the Centers for Medicare and Medicaid Services to reduce payments to hospitals with excess readmissions for COPD as of 2015. This study sought to develop a predictive readmission scale to identify COPD patients at higher readmission risk.MethodsDemographic and clinical data on 339,389 patients from New York and California (derivation cohort) and 258,113 patients from Washington and Florida (validation cohort) were abstracted from the State Inpatient Database (2006–2011), and the Readmission After COPD Exacerbation (RACE) Scale was developed to predict 30-day readmission risk.ResultsThirty-day COPD readmission rates were 7.54% for the derivation cohort and 6.70% for the validation cohort. Factors including age 40–65 years (odds ratio [OR] 1.17; 95% CI, 1.12–1.21), male gender (OR 1.16; 95% CI, 1.13–1.19), African American (OR 1.11; 95% CI, 1.06–1.16), 1st income quartile (OR 1.10; 95% CI, 1.06–1.15), 2nd income quartile (OR 1.06; 95% CI, 1.02–1.10), Medicaid insured (OR 1.83; 95% CI, 1.73–1.93), Medicare insured (OR 1.45; 95% CI, 1.38–1.52), anemia (OR 1.05; 95% CI, 1.02–1.09), congestive heart failure (OR 1.06; 95% CI, 1.02–1.09), depression (OR 1.18; 95% CI, 1.14–1.23), drug abuse (OR 1.17; 95% CI, 1.09–1.25), and psychoses (OR 1.19; 95% CI, 1.13–1.25) were independently associated with increased readmission rates, P<0.01. When the devised RACE scale was applied to both cohorts together, it explained 92.3% of readmission variability.ConclusionThe RACE Scale reliably predicts an individual patient’s 30-day COPD readmission risk based on specific factors present at initial admission. By identifying these patients at high risk of readmission with the RACE Scale, patient-specific readmission-reduction strategies can be implemented to improve patient care as well as reduce readmissions and health care expenditures.

show abstract

“…Patients admitted with an exacerbation experienced a marked decline in their lung function, worse quality of life and shorter survival [3,6,23]. In addition, hospitalized COPD patients have an increased risk of new hospital readmission [4,5]. Previous studies have identified "frequent exacerbator phenotype," which is independent of disease severity, defined as those COPD patients who had 2 or more exacerbations [9].…”

Section: Discussionmentioning

confidence: 99%

“…Patients admitted with an exacerbation have an increased risk of future hospital readmissions [4,5], which is also related with a progressive increase in the risk of death [6]. Therefore, COPD patients with frequent hospitalized exacerbations (FHE) are a population with important clinical and social implications [7,8].…”

Section: Introductionmentioning

confidence: 99%

<b><i>Pseudomonas aeruginosa</i></b> in Chronic Obstructive Pulmonary Disease Patients with Frequent Hospitalized Exacerbations: A Prospective Multicentre Study

et al. 2018

View full text Add to dashboard Cite

Background: Pseudomonas aeruginosa (PA) is a common microorganism related to severe exacerbations in Chronic Obstructive Pulmonary Disease (COPD). However, their role in COPD patients with frequent hospitalized exacerbations (FHE) is not well described. Objectives: We aimed to determine prevalence, risk factors, susceptibility patterns and impact on outcomes of PA in COPD patients with FHE. Methods: Prospective observational multicentre study that included COPD patients with FHE. The cohort was stratified in 2 groups according to the presence or absence of PA isolation in sputum. Patients were followed up for 12 months. Results: We enrolled 207 COPD patients with FHE. In 119 patients (57%), a valid sputum culture was collected. Of them, PA was isolated in 21 patients (18%). The risk factors associated with PA were prior use of systemic corticosteroids (OR 3.3, 95% CI 1.2–9.7, p = 0.01) and prior isolation of PA (OR 4.36, 95% CI 1.4–13.4, p < 0.01). Patients with PA had an increased risk of having ≥3 readmissions (OR 4.1, 95% CI 1.3–12.8, p = 0.01) and higher PA isolation rate (OR 7.7, 95% CI 2.4–24.6, p < 0.001) during the follow-up period. In 14 patients (67%), PA was resistant to at least one antibiotic tested. PA persisted in the sputum in 70% of patients. Conclusions: The presence of PA was related to 3 or more readmissions during the 1-year follow-up and PA persisted in the sputum despite an appropriate antibiotic treatment. This finding suggested an important role of PA in the course of the disease of COPD patients with FHE.

show abstract

A retrospective analysis to identify predictors of COPD-related rehospitalization

Cited by 31 publications

References 22 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

Readmission After COPD Exacerbation Scale: determining 30-day readmission risk for COPD patients

<b><i>Pseudomonas aeruginosa</i></b> in Chronic Obstructive Pulmonary Disease Patients with Frequent Hospitalized Exacerbations: A Prospective Multicentre Study

Contact Info

Product

Resources

About