Contribution of social factors to readmissions within 30 days after hospitalization for COPD exacerbation

Abstract

Background To investigate whether, in patients hospitalized for COPD, the addition of social factors improves the predictive ability for the risk of overall 30-day readmissions, early readmissions (within 7 days after discharge), and late readmissions (8–30 days after discharge). Methods Patients (aged ≥40 years) hospitalized for COPD were identified in the Medicare Current Beneficiary Survey from 2006 through 2012. With the use of 1000 bootstrap resampling from the original cohort (training-set), two prediction models were derived: 1) the reference model including age, comorbidities, and mechanical ventilation use, and 2) the optimized model including social factors (e.g., educational level, marital status) in addition to the covariates in the reference model. Prediction performance was examined separately for 30-day, early, and late readmissions. Results Following 905 index hospitalizations for COPD, 18.5% were readmitted within 30 days. In the test-set, for overall 30-day readmissions, the discrimination ability between reference and optimized models did not change materially (C-statistic, 0.57 vs. 0.58). By contrast, for early readmissions, the optimized model had significantly improved discrimination (C-statistic, 0.57 vs. 0.63; integrated discrimination improvement [IDI], 0.018 [95%CI, 0.003–0.032]) and reclassification (continuous net reclassification index [NRI], 0.298 [95%CI 0.060–0.537]). Likewise, for late readmissions, the optimized model also had significantly improved discrimination (C-statistic, 0.65 vs. 0.68; IDI, 0.026 [95%CI 0.009–0.042]) and reclassification (continuous NRI, 0.243 [95%CI 0.028–0.459]). Conclusions In a nationally-representative sample of Medicare beneficiaries hospitalized for COPD, we found that the addition of social factors improved the predictive ability for readmissions when early and late readmissions were examined separately.

Early readmission and its predictors among patients treated for acute exacerbations of chronic obstructive respiratory disease in Ethiopia: A prospective cohort study

“…Regarding an overall rate of 30-days readmission, our finding (21(18.01%)) was almost similar with studies conducted in Chicago [37], Ohio [38], Spain [26], and USA [39] which revealed an overall 30-days readmission rate of 18.5%, 18.1%, 17.98%, and 19.4% respectively. However, it's inconsistent with studies conducted by Buyantseva et al [40], and Meservey et al [41] that reported a higher 30-days readmission rate of 39%, and 23% respectively.…”

Contemporary perspectives in COPD: Patient burden, the role of gender and trajectories of multimorbidity

“…Females have an increased risk of hospitalization for COPD compared with males [relative risk (RR) = 1.5 (1.2–2.1) to 3.6 (1.4–9)] 143 . Female representation among patients hospitalized for COPD exacerbation is increasing over time 147 and females are at higher risk of readmission 148 …”

Prediction of readmission in patients with acute exacerbation of chronic obstructive pulmonary disease within one year after treatment and discharge

“…This indicated that XGBoost model was better than logistic model in predicting the risk of readmission in patients with AECOPD within one year. Currently, the prediction of the risk of readmission in patients with AECOPD was focused on 30 days and 90 days after treatment and discharge [ 10 – 12 , 40 ], but 30 days or 90 days could not actually represent the disease procession. The readmission of AECOPD patients within one year indicated the long-term prognosis of patients.…”

“…Currently, there was no international universal prediction model for predicting the readmission of AECOPD patients within one year after discharge. Prediction models of readmission in patients with AECOPD were established based on the data of USA or UK people and some of them were focused on predicting the risk of readmission of AECOPD patients within 30 days based on social factors or LACE index (length of stay, acuity of admission, co-morbidities, and emergency department visits within the last 6 months) [ 10 , 11 ]. Additionally, the prediction models for readmission of AECOPD patients within 90 days were also established based on PEARL (previous admissions, eMRCD score, Age, Right-sided heart failure and Left-sided heart failure) or COPD-2-HOME score (CAT score, hyperinflation, obstruction, prior admission, eosinophilia) [ 12 , 13 ].…”