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Evaluating Modifiable Risk Factors for Patients Readmitted Within 30 Days of an Acute Exacerbation of CODP: A Single Center Perspective FREE TO VIEW

Jessica Barks; Edward Ellerbeck; Patrick Harper; Travis Gratton; John Meyer; Matthew Wilson; Heath Latham
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University of Kansas Medical Center, Kansas City, KS

Chest. 2014;146(4_MeetingAbstracts):59A. doi:10.1378/chest.1987013
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SESSION TITLE: COPD 30-Day Readmission

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Tuesday, October 28, 2014 at 11:00 AM - 12:15 PM

PURPOSE: COPD affects over 13 million adults in the United States and is the third leading cause of death. Hospitalizations due to acute exacerbations of COPD (AECOPD) and early re-admission are major contributors to morbidity, mortality, and the economic impact of this chronic disease. We evaluated the following modifiable risk factors: post-discharge symptom reporting, post-discharge follow-up and medication adherence to assess whether these factors contribute to re-admission rates.

METHODS: After approval by the institutions Human Subjects Committee, discharge data were analyzed on 47 patients re-admitted within 30 days of discharge for an AECOPD between March 2012 and February 2013. Measures included post-discharge symptom reporting by the patient, completion of a follow-up visit with the patient's PCP or pulmonary physician, and medication adherence at time of re-admission. Descriptive statistics were generated when applicable.

RESULTS: Forty seven re-admissions were evaluated which represented 22 percent of AECOPD admissions for the study period. Sixty-two percent of re-admissions occurred within 2 weeks of discharge. Sixty and 89 percent of patients reported symptoms within 3 days of hospital discharge and one day of re-admission, respectively. Only 24 percent of patients contacted a provider prior to re-admission. Seventy-seven percent of subjects were provided a follow-up appointment within 4 weeks of discharge, and 40 percent of patients were re-admitted prior to this follow-up. There was no significant difference in providing follow-up appointment based on discharge day of the week. Eighty percent of patients were adherent to their discharge medications.

CONCLUSIONS: Post-discharge symptom reporting, discharge follow-up, and adherence to medications are modifiable risk factors that could be areas of focus to reduce re-admissions for AECOPD. Our results indicate that a significant percentage of patients do not report symptoms to providers and are re-admitted prior to follow-up. It is conceivable that patient centered education programs focused on symptom reporting and COPD action plans as well as improved discharge planning to arrange earlier follow-up, including phone contact within 3 days of discharge, may improve patient care and reduce AECOPD re-admissions.

CLINICAL IMPLICATIONS: These results will guide a multidisciplinary team to formalize a care pathway for our institution's COPD population with goals of limiting care variation, improving patient satisfaction, and reducing re-admission rates.

DISCLOSURE: The following authors have nothing to disclose: Jessica Barks, Edward Ellerbeck, Patrick Harper, Travis Gratton, John Meyer, Matthew Wilson, Heath Latham

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