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Predicting High Mortality Rates in Chronic Obstructive Pulmonary Disease FREE TO VIEW

Bradley Harrold; Karen Vogel; Taylor Pressler; Frank Ferris; Bruce Vanderhoff; Richard Snow
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OhioHealth, Columbus, OH

Chest. 2014;146(4_MeetingAbstracts):687A. doi:10.1378/chest.1994325
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SESSION TITLE: End-of-Life Care Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Hospitalizations for Chronic Obstructive Pulmonary Disease (COPD) exacerbations are associated with increased mortality following discharge. This mortality risk is not spread equally across all hospitalized patients. A simplified scheme for identifying hospitalized COPD patients with a particularly high predicted mortality may allow for more appropriate application of resources and might result in more intensive and focused care. To better define a high risk group, we determined the risk of mortality in COPD patients with DRGs 190, 191, and 192 discharged to a skilled nursing facility (SNF) and compared it to those discharged elsewhere.

METHODS: A retrospective analysis was performed using the US Center for Medicare and Medicaid Service (CMS) data for the approximate 500,000 Medicare beneficiaries living in central and southeast Ohio. The risk of mortality over one year for COPD patients discharged to a SNF was estimated following their first hospitalization for DRGs 190, 191, and 192 during 2008 and 2009. Kaplan Meier survival curves were used to analyze the risk of mortality.

RESULTS: For patients discharged to a SNF with a DRG 190, the probability of death at 180 days post hospital discharge was 33.9%, and was 46.5% at 360 days post hospital discharge. This can be compared to a mortality risk of 16.4% at 180 days and 23.9% at 360 days for patients not discharged to a SNF. The additional DRGs also demonstrated high mortality rates.

CONCLUSIONS: Patients admitted for a COPD exacerbation and discharged to a SNF have high mortality rates. These rates approach a 1/2 risk of death at one year for the higher acuity DRG. The high mortality rates for COPD patients discharged to a SNF likely reflect more severe underlying COPD, the presence of multiple chronic conditions, and/ or poor physical conditioning.

CLINICAL IMPLICATIONS: Understanding which COPD patients are at particularly high risk for death might allow providers to better match the intensity of health care services with the medical necessity. These intensive services might include enhanced care in SNFs and more intensive COPD management programs. Future work may allow more narrowly defined patient groups likely to demonstrate a favorable response to intensive programs and whether these programs can improve survival. Alternatively, patients unlikely to show clinical improvement could receive benefit from early palliative care and hospice care.

DISCLOSURE: The following authors have nothing to disclose: Bradley Harrold, Karen Vogel, Taylor Pressler, Frank Ferris, Bruce Vanderhoff, Richard Snow

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