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Recent Advances in Chest Medicine |

COPD Readmissions: Addressing COPD in the Era of Value-based Health Care

Tina Shah, MD, MPH; Valerie G. Press, MD, MPH; Megan Huisingh-Scheetz, MD, MPH; Steven R. White, MD
Author and Funding Information

FUNDING/SUPPORT: Dr Shah received support from the National Institutes of Health National Heart, Lung and Blood Institute (NHLBI) Research Training in Respiratory Biology Grant (T32 HL007605). Dr Press received support from the NHLBI (K23 HL-118151) and from the National Center for Advancing Translational Sciences (U54 TR000430). Dr Huisingh-Sheetz received support from the American Federation for Aging Research/John A. Hartford Foundation’s Center of Excellence in Geriatric Medicine and Training National Program Award, from the Patient-Centered Outcomes Research Institute (IH-12-11-4259), and the National Center for Advancing Translational Sciences (U54 TR000430). Dr White received support from the NHLBI (U10 HL-098096) and the National Institute of Allergy and Infectious Diseases (AI-095230).

aSection of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, IL

bSection of Hospital Medicine, University of Chicago, Chicago, IL

cSection of Geriatrics and Palliative Medicine, Department of Medicine, University of Chicago, Chicago, IL

CORRESPONDENCE TO: Steven R. White, MD, Section of Pulmonary and Critical Care Medicine, University of Chicago, 5841 S. Maryland Ave, MC6076, Chicago, IL 60637


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;150(4):916-926. doi:10.1016/j.chest.2016.05.002
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Of those patients hospitalized for an exacerbation of COPD, one in five will require rehospitalization within 30 days. Many developed countries are now implementing policies to increase care quality while controlling costs for COPD, known as value-based health care. In the United States, COPD is part of Medicare’s Hospital Readmissions Reduction Program (HRRP), which penalizes hospitals for excess 30-day, all-cause readmissions after a hospitalization for an acute exacerbation of COPD, despite minimal evidence to guide hospitals on how to reduce readmissions. This review outlines challenges for improving overall COPD care quality and specifically for the HRRP. These challenges include heterogeneity in the literature for how COPD and readmissions are defined, difficulty finding the target population during hospitalizations, and a lack of literature to guide evidence-based programs for COPD readmissions as defined by the HRRP in the hospital setting. It then identifies risk factors for early readmissions after acute exacerbation of COPD and discusses tested and emerging strategies to reduce these readmissions. Finally, we evaluate the current HRRP and future policy changes and their effect on the goal to deliver value-based COPD care. COPD remains a chronic disease with a high prevalence that has finally garnered the attention of health systems and policy makers, but we still have a long way to go to truly deliver value-based care to patients.


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