SESSION TYPE: COPD: Outcomes
PRESENTED ON: Wednesday, October 24, 2012 at 02:45 PM - 04:15 PM
PURPOSE: Readmission rates in the United States are high. A recent study suggests that approximately 19.6% of all Medicare patients require readmission within thirty days of initial hospital discharge at an annual cost of seventeen billion dollars. This publication reported a thirty-day readmission rate for patients discharged with COPD exacerbation of 22.6%. The purpose of our study is to evaluate to what degree participation in a COPD transitional care clinic (CTCC) impacts thirty-day readmission rates.
METHODS: Ohio State University Hospital East (OSUHE) is an urban, 175 bed community hospital. Starting August 1st 2011, all patients discharged from OSUHE with a primary discharge diagnosis of COPD exacerbation were eligible to be scheduled an appointment in the CTCC within one week of discharge. CTCC visits were conducted by an advanced practice nurse (APN). Visits focused on medication reconciliation, inhaler technique training, immunization, risk stratification through pulmonary function testing, enrollment in pulmonary rehabilitation, smoking cessation counseling and long-term pulmonary referral when indicated. The thirty-day readmission rate for patients who participated in the CTCC was determined. This rate was compared to the thirty-day readmission rate for patients who no-showed for their PTCC appointment and to the 2010 OSUHE benchmark rate.
RESULTS: In 2010, 210 patients were discharged from OSUHE with a primary discharge diagnosis of COPD exacerbation. Thirty-four of these patients were readmitted within thirty days (16%). Between August 1st 2011 and March 15th 2012, fifty-three patients were seen in the CTCC. Seven of these patients required readmission within thirty days (13%). Forty patients no-showed for their CTCC appointment. Nine of these patients required readmission within thirty days (23%).
CONCLUSIONS: Patients discharged with COPD exacerbation who participated in an APN-led transitional care clinic had a lower risk of readmission within 30 days compared to the OSUHE 2010 benchmark rate. In addition, patients participating in the CTCC were less likely to require readmission to the hospital within thirty days than patients who no-showed for their CTCC appointment.
CLINICAL IMPLICATIONS: Further analysis is necessary to determine if the transitional clinic initiative decreased the hospital-wide readmission rate for patients with COPD exacerbation. Due to the high no-show rate, future endeavors will be directed at providing transitional care via teleconferencing and in-home visits.
DISCLOSURE: The following authors have nothing to disclose: Dylan Wirtz, James Allen
No Product/Research Disclosure InformationOhio State University, Columbus, OH