Team-based approach reduces readmissions for COPD

An interprofessional, multicare setting program led to a nearly 50% reduction in 30-day all-cause chronic obstructive pulmonary disease readmissions, according to findings presented at the Society of Hospital Medicine Annual Meeting.

Tina Shah, MD, MPH, of the University of Chicago, and colleagues developed the program to reduce all-cause 30-day readmission for patients admitted with acute exacerbation of COPD, a leading cause of readmissions. The researchers assessed prespecified discharge coding guidelines within the Medicare Hospital Readmissions Reductions Program to define acute exacerbation of COPD, then used chart review and patient follow-up data to determine health care utilization at the hospital within 30 days.

They used a quality improvement model from February 2014 to August 2015 to develop their inter-professional program, which included:

nurse-led inpatient pulmonary consultation;
one-week follow-up at an outpatient clinic;
self-management education (COPD action plan);
pharmacy-led medication reconciliation;
inhaler technique instruction;
a 24-hour patient phone line; and
a postdischarge call after 48 hours.

The investigators found that out of 583 admissions for acute exacerbation of COPD, 91 (15.6%) were readmitted within 30 days from February through August 2015. During the intervention period, the 3-month average readmission rate decreased from 26% to 11%. The results also revealed that respiratory-related diseases accounted for 62% of readmissions — COPD and asthma each accounted for 20% — and cardiac etiologies accounted for 16%. Shah and colleagues observed no significant increase in utilization of the ED or observation status during the intervention period. Median time to readmission was 15 days, and median time to observation stay was 8 days. Compared with national data, median time to readmission was 1.25 times longer, suggesting follow-up within 1 week may be beneficial to COPD patients.

These findings indicate that a team-based targeted intervention with a comprehensive program can cut the number of early admissions attributed to acute exacerbation of COPD, according to the researchers. – by Savannah Demko

References:

Shah T, et al. “Driving down readmissions: Evaluation of an interprofessional program to reduce readmissions after COPD.” Presented at: Society of Hospital Medicine Annual Meeting; May 1-4, 2017; Las Vegas.

Disclosures: Healio Internal Medicine was unable to confirm any relevant financial disclosures prior to publication.