The Quality of Obstructive Lung Disease Care for Adults in the United States as Measured by Adherence to Recommended Processes

Mularski, Richard A.; Asch, Steven M.; Shrank, William H.; Kerr, Eve A.; Setodji, Claude Messan; Adams, John; Keesey, Joan; McGlynn, Elizabeth A.

doi:10.1378/chest.130.6.1844

Cited by 114 publications

(61 citation statements)

References 36 publications

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“…However, it is less apparent why ED visits in the South were associated with a lower likelihood of prescription of systemic corticosteroids compared with the Northeast. Prior studies have demonstrated regional variations in the quality of care for stable COPD 35 and in hospital care for AE-COPD; 36 we extend this finding to a previously unstudied ED population. Future studies should assess reasons for this disparity, particularly at the ED level, and identify the barriers to the delivery of high-quality emergency care.…”

Section: Discussionsupporting

confidence: 60%

National Study of Emergency Department Visits for Acute Exacerbation of Chronic Obstructive Pulmonary Disease, 1993–2005

Tsai

Sobrino

Camargo

2008

Academic Emergency Medicine

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Objectives: Little is known about recent trends in U.S. emergency department (ED) visits for acute exacerbation of chronic obstructive pulmonary disease (AECOPD) or about ED management of AECOPD. This study aimed to describe the epidemiology of ED visits for AECOPD and to evaluate concordance with guideline-recommended care.Methods: Data were obtained from National Hospital Ambulatory Medical Care Survey (NHAMCS). ED visits for AECOPD, during 1993 to 2005, were identified using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. Concordance with guideline recommendations was evaluated using process measures.Results: Over the 13-year study period, there was an average annual 0.6 million ED visits for AECOPD, and the visit rates for AECOPD were consistently high (3.2 per 1,000 U.S. population; P trend = 0.13). The trends in the use of chest radiograph, pulse oximetry, or bronchodilator remained stable (all P trend > 0.5). By contrast, the use of systemic corticosteroids increased from 29% in 1993-1994 to 60% in 2005, antibiotics increased from 14% to 42%, and methylxanthines decreased from 15% to <1% (all P trend < 0.001). Multivariable analysis showed patients in the South (vs. the Northeast) were less likely to receive systemic corticosteroids (odds ratio [OR] = 0.6; 95% confidence interval [CI] = 0.4 to 0.9). Conclusions:The high burden of ED visits for AECOPD persisted. Overall concordance with guidelinerecommended care for AECOPD was moderate, and some emergency treatments had improved over time.

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Section: Discussionsupporting

confidence: 60%

National Study of Emergency Department Visits for Acute Exacerbation of Chronic Obstructive Pulmonary Disease, 1993–2005

Tsai

Sobrino

Camargo

2008

Academic Emergency Medicine

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“…Unfortunately, applicable standards are often forgotten during treatment [20,[31][32][33][34][35]. Furthermore, many patients do not adhere to medical recommendations concerning taking drugs or non-pharmacological treatment [19,34,36].…”

Section: Discussionmentioning

confidence: 99%

Factors Influencing Adherence to Treatment in COPD Patients and Its Relationship with Disease Exacerbations

Wiśniewski

Porzezińska

Gruchała‐Niedoszytko

et al. 2014

Advances in Respiratory Medicine

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Introduction: Chronic obstructive pulmonary disease (COPD) is one of the leading causes of morbidity and mortality in the world. Systematic treatment of COPD decreases symptoms and reduces the frequency of exacerbations and hospitalisations because of the disease. It is estimated that only 50% of patients use prescribed drugs systematically. The aim of this study was to identify the factors which can influence adherence to treatment of the patients who were treated due to exacerbation of COPD. Material and Methods: A questionnaire probe was conducted on 49 patients hospitalised at the Regional Lung and Tuberculosis Hospital in Olsztyn, Poland due to COPD exacerbation. The assessed variables were: quality of life and adherence to treatment 30 days after discharge from hospital in relationship with demographic factors, social status, disease and hospitalisation course, and relief after systematic treatment. Results: Most of the patients assessed their health condition as poor and the disease as limiting their everyday social and occupational activity. 30 days after discharge from hospital the adherence rate to therapy was only 67%. There was an association between systematic treatment and the rate of exacerbations (p = 0.045) and hospitalisations (p = 0.005) but also clinical benefit after long-term treatment (p = 0.023). There were no associations between adherence to treatment and sex, place of residence, education or occupation. Conclusions: Lack of systematic treatment is the main risk factor for COPD exacerbations and hospitalisation rate. A subjective sense of relief after drugs is a factor improving patients’ compliance.

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“…In the United States, COPD is responsible for more than 1.5 million emergency room visits and 725,000 hospitalizations annually, with resulting healthcare costs approaching $60 billion (9, 10). Among patients hospitalized for AECOPD, 34 to 40% do not receive recommended therapies (11,12), whereas nearly half receive at least one inappropriate or potentially harmful therapy (11). Approximately 22.6% of patients discharged after AECOPD have an all-cause 30-day readmission, highlighting the significant impact to patients, payers, and healthcare systems (6).…”

Section: Historical Perspective: the Cms Hospital Readmission Reductimentioning

confidence: 99%

Penalizing Hospitals for Chronic Obstructive Pulmonary Disease Readmissions

Feemster

2014

Am J Respir Crit Care Med

102

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In October 2014, the U.S. Centers for Medicare and Medicaid Services (CMS) will expand its Hospital Readmission Reduction Program (HRRP) to include chronic obstructive pulmonary disease (COPD). Under the new policy, hospitals with high risk-adjusted, 30-day all-cause unplanned readmission rates after an index hospitalization for a COPD exacerbation will be penalized with reduced reimbursement for the treatment of Medicare beneficiaries. In this perspective, we review the history of the HRRP, including the recent addition of COPD to the policy. We critically assess the use of 30-day all-cause COPD readmissions as an accountability measure, discussing potential benefits and then highlighting the substantial drawbacks and potential unintended consequences of the measure that could adversely affect providers, hospitals, and patients with COPD. We conclude by emphasizing the need to place the 30-day COPD readmission measure in the context of a reconceived model for postdischarge quality and review several frameworks that could help guide this process.

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The Quality of Obstructive Lung Disease Care for Adults in the United States as Measured by Adherence to Recommended Processes

Cited by 114 publications

References 36 publications

National Study of Emergency Department Visits for Acute Exacerbation of Chronic Obstructive Pulmonary Disease, 1993–2005

National Study of Emergency Department Visits for Acute Exacerbation of Chronic Obstructive Pulmonary Disease, 1993–2005

Factors Influencing Adherence to Treatment in COPD Patients and Its Relationship with Disease Exacerbations

Penalizing Hospitals for Chronic Obstructive Pulmonary Disease Readmissions

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