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Correspondence |

COPD Bundle to Prevent Hospital Readmissions and ED VisitsCOPD Readmissions FREE TO VIEW

Farhan Zaidi, MD; Valentin Prieto-Centurion, MD; Jerry A. Krishnan, MD, PhD, FCCP
Author and Funding Information

From the Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Illinois at Chicago.

CORRESPONDENCE TO: Jerry A. Krishnan, MD, PhD, FCCP, Division of Pulmonary, Critical Care, Sleep and Allergy, Department of Medicine, University of Illinois at Chicago, 840 S Wood St (MC 719), Room 920-N CSB, Chicago, IL 60612-7323; e-mail: jakris@uic.edu


Editor’s Note: Authors are invited to respond to Correspondence that cites their previously published work. Those responses appear after the related letter. In cases where there is no response, the author of the original article declined to respond or did not reply to our invitation.

FINANCIAL/NONFINANCIAL DISCLOSURES: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

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


Chest. 2015;148(3):e91. doi:10.1378/chest.15-0725
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To the Editor:

The search for interventions to reduce avoidable readmissions after an exacerbation of COPD has attracted substantial attention after the Centers for Medicare & Medicaid Services included COPD exacerbations in its Hospital Readmissions Reduction Program.1 We read with great interest the study by Jennings et al2 in a recent issue of CHEST (May 2015) and applaud the authors for conducting a randomized clinical trial to test the effects of a predischarge care bundle. The study demonstrated a numerically lower but not statistically significant risk of 30-day readmissions or visits to the ED in the intervention group (risk difference, −3.4%; 95% CI, −15.7% to 8.8%). The authors acknowledged several potential limitations in the study design, including relying on the primary team to implement interventions directed at risk factors identified by the researchers and the selective eligibility criteria.

We propose another limitation. The study used a highly optimistic effect size (50% reduction from 20% to 10%) for sample size calculations and was, therefore, underpowered to test the hypothesis that a predischarge care bundle can reduce postdischarge readmissions or ED visits. Why was this large effect size proposed? Overall, the study highlights the continued need to identify interventions that reduce readmissions in patients with COPD exacerbations.

References

Readmissions reduction program. Centers for Medicare & Medicaid Services website. http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/Readmissions-Reduction-Program.html. Updated August 2014. Accessed December 28, 2014.
 
Jennings JH, Thavarajah K, Mendez MP, Eichenhorn M, Kvale P, Yessayan L. Predischarge bundle for patients with acute exacerbations of COPD to reduce readmissions and ED visits: a randomized, controlled trial. Chest. 2015;147(5):1227-1234. [CrossRef] [PubMed]
 

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References

Readmissions reduction program. Centers for Medicare & Medicaid Services website. http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/Readmissions-Reduction-Program.html. Updated August 2014. Accessed December 28, 2014.
 
Jennings JH, Thavarajah K, Mendez MP, Eichenhorn M, Kvale P, Yessayan L. Predischarge bundle for patients with acute exacerbations of COPD to reduce readmissions and ED visits: a randomized, controlled trial. Chest. 2015;147(5):1227-1234. [CrossRef] [PubMed]
 
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