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Original Research: COPD |

Understanding Why Patients With COPD Get ReadmittedUnderstanding Readmissions After COPD: A Large National Study to Delineate the Medicare Population for the Readmissions Penalty Expansion

Tina Shah, MD, MPH; Matthew M. Churpek, MD, PhD; Marcelo Coca Perraillon, MA; R. Tamara Konetzka, PhD
Author and Funding Information

From the Department of Pulmonary and Critical Care (Drs Shah and Churpek), The University of Chicago Medicine, and Department of Public Health Science (Mr Coca Perraillon and Dr Konetzka), The University of Chicago, Chicago, IL.

CORRESPONDENCE TO: Tina Shah, MD, MPH, Department of Pulmonary and Critical Care, The University of Chicago Medicine, 5841 S Maryland Ave, MC 6076, Chicago, IL 60637; e-mail: tina.shah@uchospitals.edu


FOR EDITORIAL COMMENT SEE PAGE 1199

Part of this article has been presented in abstract form at ATS 2014, May 16-21, 2014, San Diego, CA.

FUNDING/SUPPORT: This study was supported by the Agency for Healthcare Research and Quality [Grant AHRQ R21HS021877] and by a National Institutes of Health National Heart, Lung, and Blood Institute Research Training in Respiratory Biology [Grant T32 HL007605]. Dr Churpek has received grant support from the National Institutes of Health [K08 HL121080].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;147(5):1219-1226. doi:10.1378/chest.14-2181
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BACKGROUND:  The Hospital Readmissions Reduction Program (HRRP) penalizes hospitals for 30-day readmissions and was extended to COPD in October 2014. There is limited evidence available on readmission risk factors and reasons for readmission to guide hospitals in initiating programs to reduce COPD readmissions.

METHODS:  Medicare claims data from 2006 to 2010 in seven states were analyzed, with an index admission for COPD defined by discharge International Classification of Diseases, Ninth Revision, codes as stipulated in the HRRP guidelines. Rates of index COPD admission and readmission, patient demographics, readmission diagnoses, and use of post-acute care (PAC) were investigated.

RESULTS:  Over the study period, there were 26,798,404 inpatient admissions, of which 3.5% were index COPD admissions. At 30 days, 20.2% were readmitted to the hospital. Respiratory-related diseases accounted for only one-half of the reasons for readmission, and COPD was the most common diagnosis, explaining 27.6% of all readmissions. Patients discharged home without home care were more likely to be readmitted for COPD than patients discharged to PAC (31.1% vs 18.8%, P < .001). Readmitted beneficiaries were more likely to be dually enrolled in Medicare and Medicaid (30.6% vs 25.4%, P < .001), have a longer median length of stay (5 days vs 4 days, P < .0001), and have more comorbidities (P < .001).

CONCLUSIONS:  Medicare patients with COPD exacerbations are usually not readmitted for COPD, and these reasons differ depending on PAC use. Readmitted patients are more likely to be dually enrolled in Medicare and Medicaid, suggesting that the addition of COPD to the readmissions penalty may further worsen the disproportionately high penalties seen in safety net hospitals.

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