Understanding Why COPD Patients Get Readmitted: A Large National Study to Delineate the Medicare Population for the Readmissions Penalty Expansion.

Link to article at PubMed

Understanding Why COPD Patients Get Readmitted: A Large National Study to Delineate the Medicare Population for the Readmissions Penalty Expansion.

Chest. 2014 Dec 24;

Authors: Shah T, Churpek MM, Coca Perraillon M, Konetzka RT

Abstract
Abstract: Background:The Hospital Readmissions Reduction Program (HRRP) penalizes hospitals for 30-day readmissions and was extended to chronic obstructive lung disease (COPD) in October 2014. There is limited evidence available on readmission risk factors and reasons for readmission to guide hospitals to initiate programs to reduce COPD readmissions. Methods:Medicare claims data from seven states were analyzed from 2006 to 2010, with an index admission for COPD defined by discharge ICD-9 codes as stipulated in the HRRP guidelines. Rates of index COPD admission, readmission, patient demographics, readmission diagnoses and utilization of post-acute care (PAC) were investigated. Results:Over the study period, there were 26,798,404 inpatient admissions, of which 3.5% were index COPD admissions. At 30 days, 20.2% were readmitted to the hospital. Respiratory-related diseases accounted for only half of the reasons for readmission and COPD was the most common diagnosis, explaining 27.6% of all readmissions. Patients discharged home without home healthcare were more likely to be readmitted for COPD than patients discharged to PAC (31.1% v. 18.8%, p<0.001). Readmitted beneficiaries were more likely to be dually enrolled in Medicare and Medicaid (30.6% v. 25.4%, p<0.001), have a longer median length of stay (5 v. 4 days, p<0.0001), and have more comorbidities (p<0.001). Conclusion:Medicare patients with COPD exacerbations are usually not readmitted for COPD, and these reasons differ depending on PAC utilization. Readmitted patients are more likely duals, suggesting that the addition of COPD to the readmissions penalty may further exacerbate the disproportionately high penalties seen in safety-net hospitals.
Background: The Hospital Readmissions Reduction Program (HRRP) penalizes hospitals for 30-day readmissions and was extended to chronic obstructive lung disease (COPD) in October 2014. There is limited evidence available on readmission risk factors and reasons for readmission to guide hospitals to initiate programs to reduce COPD readmissions.
Methods: Medicare claims data from seven states were analyzed from 2006 to 2010, with an index admission for COPD defined by discharge ICD-9 codes as stipulated in the HRRP guidelines. Rates of index COPD admission, readmission, patient demographics, readmission diagnoses and utilization of post-acute care (PAC) were investigated.
Results: Over the study period, there were 26,798,404 inpatient admissions, of which 3.5% were index COPD admissions. At 30 days, 20.2% were readmitted to the hospital. Respiratory-related diseases accounted for only half of the reasons for readmission and COPD was the most common diagnosis, explaining 27.6% of all readmissions. Patients discharged home without home healthcare were more likely to be readmitted for COPD than patients discharged to PAC (31.1% v. 18.8%, p<0.001). Readmitted beneficiaries were more likely to be dually enrolled in Medicare and Medicaid (30.6% v. 25.4%, p<0.001), have a longer median length of stay (5 v. 4 days, p<0.0001), and have more comorbidities (p<0.001).
Conclusion: Medicare patients with COPD exacerbations are usually not readmitted for COPD, and these reasons differ depending on PAC utilization. Readmitted patients are more likely duals, suggesting that the addition of COPD to the readmissions penalty may further exacerbate the disproportionately high penalties seen in safety-net hospitals.

PMID: 25539483 [PubMed - as supplied by publisher]

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