Readmissions Reduction Program: Mortality and Readmissions for Chronic Obstructive Pulmonary Disease

Neira, Daniel Puebla; Hsu, Enshuo; Kuo, Yong‐Fang; Ottenbacher, Kenneth J.; Sharma, Gulshan

doi:10.1164/rccm.202002-0310oc

Cited by 23 publications

(8 citation statements)

References 39 publications

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“…These findings were consistent with previous studies that assessed the impact of COPD care programs on the outcome of COPD patients. 6–9 In the US, the implementation of the Hospital Readmissions Reduction Program (HRRP) resulted in a reduction in the 30-day all-cause readmission rate during the implementation period compared with the preannouncement phase (18.74% vs 20.54%). 6 In Korea, the COPD Quality Assessment Program (CQAP) was launched in 2014 and, the risk of admission and all-cause mortality rate in the assessed subjects group were significantly reduced by 21.2% and 40.7%, respectively, compared to the not-assessed subjects group.…”

Section: Discussionmentioning

confidence: 99%

“… 6–9 In the US, the implementation of the Hospital Readmissions Reduction Program (HRRP) resulted in a reduction in the 30-day all-cause readmission rate during the implementation period compared with the preannouncement phase (18.74% vs 20.54%). 6 In Korea, the COPD Quality Assessment Program (CQAP) was launched in 2014 and, the risk of admission and all-cause mortality rate in the assessed subjects group were significantly reduced by 21.2% and 40.7%, respectively, compared to the not-assessed subjects group. 9 In Greece, they implemented an intervention that is comprised of 6 weeks of exercise and education sessions supervised by physiotherapists, nurses, and general practitioners.…”

Section: Discussionmentioning

confidence: 99%

“…Clinically important improvements in all outcomes after intervention were documented such as mean differences (95% CIs) for COPD Questionnaire: −0.53 (−0.81, −0.24), CAT: −5.93 (−8.27, −3.60), St. George’s Respiratory Questionnaire: −23.00 (−29.42, −16.58), Patient Health Questionnaire-9: −1.10 (−2.32, 0.12), Incremental Shuttle Walking Test: 87.39 (59.37, 115.40). 8 In summary, programs for COPD patients, 6–9 including the P4P program in Taiwan have been shown to help improve the clinical outcome of COPD patients.…”

Section: Discussionmentioning

confidence: 99%

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The Impact of the Pay-for-Performance Program on the Outcome of COPD Patients in Taiwan After One Year

Cheng¹,

Lai²,

Wang³

et al. 2022

COPD

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Objective To investigate the impact of a multidisciplinary intervention on the clinical outcomes of patients with COPD. Methods This study retrospectively extracted the data of patients enrolled in the national pay-for-performance (P4P) program for COPD in four hospitals. Only COPD patients who received regular follow-up for at least one year in the P4P program between September 2018 and December 2020 were included. Results A total of 1081 patients were included in this study. Among them, 424 (39.2%), 287 (26.5%), 179 (16.6%), and 191 (17.7%) patients were classified as COPD Groups A, B, C, and D, respectively. Dual therapy with long-acting β2-agonist (LABA)/long-acting muscarinic antagonist (LAMA) was the most used inhaled bronchodilator at baseline (n = 477, 44.1%) patients, followed by LAMA monotherapy (n = 195, 18.0%), triple therapy with inhaled corticosteroid (ICS)/LABA/LAMA (n = 184, 17.0%), and ICS/LABA combination (n = 165, 15.3%). After one year of intervention, 374 (34.6%) and 323 (29.9%) patients had their pre- and post-bronchodilator-forced expiratory volume in one second (FEV1) increase of more than 100 mL. Both the COPD Assessment Test (CAT) and modified British Medical Research Council (mMRC) scores had a mean change of −2.2 ± 5.5 and −0.3 ± 0.9, respectively. The improvement in pulmonary function and symptom score were observed across four groups. The decreased number of exacerbations was only observed in Groups C and D, and not in Groups A and B. Conclusion This real-world study demonstrated that the intervention in the P4P program could help improve the clinical outcome of COPD patients. It also showed us a different view on the use of dual therapy, which has a lower cost in Taiwan.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The Impact of the Pay-for-Performance Program on the Outcome of COPD Patients in Taiwan After One Year

Cheng¹,

Lai²,

Wang³

et al. 2022

COPD

View full text Add to dashboard Cite

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“…Whether a 30 day decrease in readmissions is linked to better patient outcomes remains unknown (273). Recently in 2020, a retrospective cohort study of readmission and mortality rates in a national cohort (N=4,587,542) was conducted and found a reduction in 30 day all-cause readmission rates during the implementation period of HRRP compared to the preannouncement phase (288). However, this was associated with a significant increase in 30-day mortality following discharge from COPD hospitalisation.…”

Section: Readmission Reduction Effortsmentioning

confidence: 99%

Mechanisms of COPD Exacerbation Recurrence

2019

CMR

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People living with chronic obstructive pulmonary disease (COPD) are susceptible to acute deteriorations in respiratory health termed "exacerbations". Hospitalisations due to exacerbations of COPD are associated with high global health-care burden and cost. Preventing COPD exacerbations resulting in hospital re-admissions is a major target in COPD care. More work is needed to understand the mechanisms of re-admissions, prevent exacerbation recurrence, and find better approaches to prevent exacerbations.

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“… 14 Patients with COPD also have a higher risk of post-discharge readmissions, and those readmitted are at increased risk of death. 15 , 16 COPD is a leading reason for office-based visits. 10 , 14 , 17 Moreover, HCU of patients with COPD is greater in current smokers with advanced age, greater number of comorbidities, and worse airflow obstruction.…”

Section: Introductionmentioning

confidence: 99%

Healthcare Utilization in Patients with Chronic Obstructive Pulmonary Disease Discharged from Coronavirus 2019 Hospitalization

Puebla Neira,

Zaidan,

Nishi

et al. 2023

COPD

Self Cite

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Rationale There is concern that patients with chronic obstructive pulmonary disease (COPD) are at greater risk of increased healthcare utilization (HCU) following Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-COV-2) infection. Objective To assess whether COPD is an independent risk factor for increased post-discharge HCU. Methods We conducted a retrospective cohort study of patients with COPD discharged home from a hospitalization due to Coronavirus Disease 2019 (COVID-19) between April 1, 2020, and March 31, 2021, using Optum’s de-identified Clinformatics ® Data Mart Database (CDM). COVID-19 was identified by an International Classification of Diseases, tenth revision, clinical modification (ICD-10-CM) diagnosis code of U07.1. The primary outcome was HCU (ie, emergency department (ED) visits, readmissions, rehabilitation/skilled nursing facility (SNF) visits, outpatient office visits, and telemedicine visits) nine months post-discharge after COVID-19 hospitalization (from here on “post-discharge”) in patients with COPD compared to HCU of patients without COPD. Poisson regression modeling was used to calculate relative risk (RR) and confidence interval (CI) for COPD, adjusted for the other covariates. Results We identified a cohort of 160,913 patients hospitalized with COVID-19, with 57,756 discharged home and 14,622 (25.3%) diagnosed with COPD. Patients with COPD had a mean age of 75.48 years (±9.49); 55.5% were female and 70.9% were White. Patients with COPD had an increased risk of HCU in the nine months post-discharge after adjusting for the other covariates. Risk of ED visits, readmissions, length of stay during readmission, rehabilitation/SNF visits, outpatient office visits, and telemedicine visits were increased by 57% (RR 1.57; 95% CI 1.53–1.60), 50% (RR 1.50; 95% CI 1.46–1.54), 55% (RR 1.55; 95% CI 1.53–1.56), 18% (RR 1.18; 95% CI 1.14–1.22), 16% (RR 1.16; 95% CI 1.16–1.17), and 28% (RR 1.28; 95% CI 1.24–1.31), respectively. Younger patients (ages 18 to 65 years), women, and Hispanic patients with COPD showed an increased risk for post-discharge HCU. Conclusion Patients with COPD hospitalized with COVID-19 experienced increased HCU post-discharge compared to patients without COPD.

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Readmissions Reduction Program: Mortality and Readmissions for Chronic Obstructive Pulmonary Disease

Cited by 23 publications

References 39 publications

The Impact of the Pay-for-Performance Program on the Outcome of COPD Patients in Taiwan After One Year

The Impact of the Pay-for-Performance Program on the Outcome of COPD Patients in Taiwan After One Year

Mechanisms of COPD Exacerbation Recurrence

Healthcare Utilization in Patients with Chronic Obstructive Pulmonary Disease Discharged from Coronavirus 2019 Hospitalization

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