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Jeffrey H. Jennings, MD; Lenar Yessayan, MD
Author and Funding Information

From the Division of Pulmonary and Critical Care Medicine, Henry Ford Health System.

CORRESPONDENCE TO: Jeffrey H. Jennings, MD, Division of Pulmonary and Critical Care Medicine, Henry Ford Health System, K-17, 2799 W Grand Blvd, Detroit, MI 48202; e-mail: jjennin2@hfhs.org


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.

FUNDING/SUPPORT: This study was supported by the Breech Chair for Health Care Quality Improvement [Grant J90002].

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-e92. doi:10.1378/chest.15-1131
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To the Editor:

We appreciate the comments by Dr Zaidi and colleagues on our recent article in CHEST.1 They ask whether the effect size in our study from 20% to 10% reduction in readmissions was overly optimistic. There is a paucity of data in the literature to guide us as to what an expected magnitude of reduction in 30-day readmission rates should be. Importantly, choosing an effect size should be based on what is “clinically meaningful.” Unfortunately, this can oftentimes be challenging and subjective. In the absence of a specific intervention, rates of 30-day readmissions for COPD range from 7% to 22%.2 We, therefore, chose an absolute reduction of 10%, given our baseline prestudy admission rate of 20% at Henry Ford.

Would choosing a smaller effect size have shown us a difference between groups? Perhaps not. While the point estimate of the risk difference was −3.5%, the CI shows that true risk difference may very well be +8.8% in favor of no intervention. Nonetheless, had the larger sample size resulted in statistical significance for this small risk difference, one might question the clinical significance of an intervention as only marginally favorable.

Acknowledgments

Role of sponsors: The sponsor had no role in the design of the study, the collection and analysis of the data, or the preparation of the manuscript.

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]
 
Elixhauser A, Au DH, Podulka J. Readmissions for Chronic Obstructive Pulmonary Disease, 2008. Statistical Brief #121. Rockville, MD: Healthcare Cost and Utilization Project (HCUP); 2006.
 

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References

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]
 
Elixhauser A, Au DH, Podulka J. Readmissions for Chronic Obstructive Pulmonary Disease, 2008. Statistical Brief #121. Rockville, MD: Healthcare Cost and Utilization Project (HCUP); 2006.
 
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