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Recent Advances in Chest Medicine |

COPD Readmissions: Addressing COPD in the Era of Value-Based Healthcare

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

Conflict of Interest: Drs. Shah, Press and Huisingh-Sheetz have no conflicts of interest to declare. Dr. White is a recipient of funding for a clinical trial from Astra-Zeneca, Inc., and has received consulting fees from Marathon Pharmaceuticals, Inc.

Funding Information: 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 (NCATS) (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 NCATS (U54 TR000430). Dr. White received support from the NHLBI (U10 HL-098096) and the National Institute of Allergy and Infectious Diseases (AI-095230).

Notation of prior publication: none

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


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


Chest. 2016. doi:10.1016/j.chest.2016.05.002
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Published online

Abstract

Of patients hospitalized for an exacerbation of chronic obstructive pulmonary disease (COPD), one in five will require re-hospitalization within 30 days. Many developed countries are now implementing policies to increase care quality while controlling costs for COPD, known as value-based healthcare. In the US, COPD is part of Medicare’s Hospital Readmission Reduction Program (HRRP), penalizing 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. This review then identifies risk factors for early readmissions after acute exacerbation of COPD (AECOPD), 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 policymakers, but we still have a long way to go to truly deliver value-based care to our patients.


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