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: Efforts to reduce 30-day readmissions are resource intensive. Healthcare systems need to target interventions at patients with the highest risk. The addition of physical functioning has been found to increase the performance of previously published risk prediction models. We examined whether functional status documented during routine nursing care in the 24 hours prior to discharge was an independent predictor of 30-day readmission risk in patients with COPD.
METHODS: Patients from a large integrated healthcare system were included in this retrospective cohort study if they were hospitalized for COPD (following the Centers for Medicare and Medicaid Services and National Quality Forum proposed criteria) and discharged between January 1, 2011, and December 31, 2012, age 40+, on a bronchodilator or steroid inhaler, alive at discharge, and continuously enrolled in the health plan 12 months prior to the index admission and at least 30-days post discharge. Our main outcome was 30-day all-cause readmission. Functional status was documented as part of routine nursing care within 24 hours prior to discharge as follows: bed bound (Level 1), able to sit (Level II), stand next to bed (Level III), walk <50 feet (Level IV), and walk >50 feet (Level V).
RESULTS: The sample included a total of 2,831 patients (n=3,536 index admissions) with a mean age of 72±11. The 30-day readmission rate was 20%. Multivariate analyses showed that patients who were non-ambulatory at discharge (Levels 1-III) were more than twice as likely to be re-admitted within 30-days compared to patients who were able to walk more than 50 feet (RR: 2.12, 95% CI 1.60 to 2.82, p<.001). There was no significant difference in readmission risk between patients who were classified as Level IV or V (p>.05).
CONCLUSIONS: Patients with COPD who were non-ambulatory within 24 hours prior to discharge were at significantly greater risk of readmission compared to ambulatory patients.
CLINICAL IMPLICATIONS: When available, functional status should be used to risk stratify patients for more intensive supportive interventions post discharge.
DISCLOSURE: The following authors have nothing to disclose: Annie Harrington, June Rondinelli, Cecelia Crawford, Smita Desai, In-Liu Liu, Janet Lee, Michael Gould, Huong Nguyen
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