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A Six Month Retrospective Analysis of 30-Day COPD Exacerbation Readmission Rates in a Metropolitan Hospital FREE TO VIEW

Bimaje Akpa, MD; Todd Rice, MS; Richard Fremont, MD
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Meharry Medical College, Nashville, TN

Chest. 2014;146(4_MeetingAbstracts):57A. doi:10.1378/chest.1993327
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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: The average readmission rate in the U.S per Medicare was estimated to be 18.4% in 2012. According to data released in 2013, 2,213 hospitals were penalized about $280 million due to readmissions. The published thirty-day readmission rate for patients discharged after COPD exacerbations is 23%. The purpose of our study was to determine whether patients who kept primary care appointments within two weeks of hospital discharge were less likely to be readmitted for COPD.

METHODS: A retrospective chart review was performed on all patients discharged from Nashville General Hospital (NGH), starting on August 1st 2013, looking at the first 100 patients with a primary diagnosis of COPD exacerbation. These patients were all given an appointment with a primary care provider (PCP) within 2 weeks of discharge. The thirty-day readmission rate was compared for patients who kept their appointment with their PCP with those who didn’t. Other variables collected included baseline characteristics, insurance status and use of controller medications.

RESULTS: 100 patients were discharged from NGH with a primary discharge diagnosis of COPD exacerbation. Twenty-three of these patients were readmitted within thirty days (23%). Between August 1st 2013 and December 31st 2013, 64 patients kept their PCP appointments. Six of these patients required readmission within 30 days (9%). Thirty-six patients did not follow up as scheduled. Seventeen of these patients required readmission within 30 days (47%). Statistically significant factor(s) for 30 day readmission rate included: seeing PCP within 2 weeks of hospital discharge (P<0.001), and number of COPD exacerbation admissions between 2011 and 2012 (p=0.036). No other factors were found to be significant including: age, insurance status, use of controller medications, or FEV1.

CONCLUSIONS: 30 day readmission rates are a large problem in the US, and recent legislation plans to link reimbursement to readmission rates. Patients who returned to visit their PCP at NGH within 2 weeks of hospital discharge for COPD exacerbation had lower risk of readmission within 30 days. Other factors such as FEV1, age and insurance status did not affect the 30-day readmission rate.

CLINICAL IMPLICATIONS: We found that in our patient population, those patients with COPD exacerbations who were seen by a PCP within 2 weeks of hospital discharge were less likely to be readmitted in 30 days. Hospital interventions that could improve follow up rates maybe a low cost way to lower 30 day readmission rates.

DISCLOSURE: The following authors have nothing to disclose: Bimaje Akpa, Todd Rice, Richard Fremont

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