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Correspondence |

Using Clinical Pathways to Assess Interventions to Prevent COPD ReadmissionsClinical Pathways and COPD Readmissions FREE TO VIEW

Jordan B. Glaser, MD; Michael Castellano, MD
Author and Funding Information

From the Division of Infectious Diseases (Dr Glaser), and the Pulmonary Division (Dr Castellano), Staten Island University Hospital.

CORRESPONDENCE TO: Jordan B. Glaser, MD, Division of Infectious Diseases, Staten Island University Hospital, 475 Seaview Ave, Staten Island, NY 10305; e-mail: JBGRYG@aol.com


CONFLICT OF INTEREST: None declared.

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


Chest. 2015;148(4):e134. doi:10.1378/chest.15-1327
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To the Editor:

Two recent articles and the accompanying editorial in CHEST (May 2015)1-3 correctly point out that 30-day readmissions after COPD are usually not for COPD exacerbations and that the effect of currently identified interventions may not vary from control groups. Risk predictors for 30-day readmissions after COPD may depend on the principal discharge diagnosis of the readmission, since the majority of readmissions are not for COPD exacerbations.

We reviewed the fiscal year 2015 Hospital Readmissions Reduction Program worksheet for our 714-bed teaching hospital. Risk variables were compared using the Fisher two-tailed exact test. Patients with 30-day readmissions after COPD for sepsis (International Classification of Diseases, 9th revision codes 0380, 03811, 03812, and 0389) had higher rates of age > 90 years (six of 38 [15.8%] vs eight of 200 [4.0%], P = .0128) and hypertensive heart and renal disease or encephalopathy (16 of 38 [42.1%] vs 42 of 200 [21.0%], P = .0120) at the time of index admission for COPD. Patients with 30-day readmissions after COPD for COPD exacerbation (International Classification of Diseases, 9th revision codes 49121 and 49122) had higher rates of lung fibrosis (29 of 75 [38.7%] vs 36 of 163 [22.1%], P = .0118) but lower rates of hypertensive heart and renal disease or encephalopathy (nine of 75 [12.0%] vs 49 of 163 [30.1%], P = .009), renal failure (18 of 75 [24.0%] vs 68 of 163 [41.7%], P = .009) and peptic ulcer disease (six of 75 [8.0%] vs 35 of 163 [21.5%], P = .0098) at the time of index admission for COPD. Age did not predict readmissions for COPD exacerbation. Effective interventions to prevent 30-day readmissions after COPD may vary and be dependent on the clinical pathway leading to the specific type (ie, diagnosis) of the readmission. This should be considered when designing trials that evaluate interventions to prevent 30-day readmissions after COPD.

References

Shah T, Churpek MM, Coca Perraillon M, Konetzka RT. Understanding why patients with COPD get readmitted: a large national study to delineate the Medicare population for the readmissions penalty expansion. Chest. 2015;147(5):1219-1226. [CrossRef] [PubMed]
 
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]
 
Mannino DM, Thomashow B. Reducing COPD readmissions: great promise but big problems. Chest. 2015;147(5):1199-1201. [CrossRef] [PubMed]
 

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References

Shah T, Churpek MM, Coca Perraillon M, Konetzka RT. Understanding why patients with COPD get readmitted: a large national study to delineate the Medicare population for the readmissions penalty expansion. Chest. 2015;147(5):1219-1226. [CrossRef] [PubMed]
 
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]
 
Mannino DM, Thomashow B. Reducing COPD readmissions: great promise but big problems. Chest. 2015;147(5):1199-1201. [CrossRef] [PubMed]
 
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