Exploring Novel Medicare Readmission Risk Variables in Chronic Obstructive Pulmonary Disease Patients at High Risk of Readmission within 30 Days of Hospital Discharge.
Ann Am Thorac Soc. 2015 Sep 8;
Authors: Glaser JB, El-Haddad H
Abstract
RATIONALE: New risk factors for 30 day readmission for chronic obstructive pulmonary disease (COPD) patients need to be identified in view of the lack of efficacy of current interventions in preventing readmission.
OBJECTIVE: To identify novel risk predictors for 30-day readmission among COPD index admissions at high risk of readmission.
METHODS: The fiscal year 2015 hospital specific HRRP workbook utilized 41 variables, each with a risk variable score. A predicted probability of readmission (PPR) was calculated for each case by using the risk variable regression coefficient and a hospital-specific effect. A PPR over 0.4 was utilized to identify COPD patients with a high risk of readmission in both the readmitted and non-readmitted groups. A percent ratio of the readmission percent divided by the non-readmission percent was generated for each risk variable for patients with a PPR >0.4. A percent ratio over three was utilized to identify high risk variables predictive of readmission. A Risk Index was defined as the number of high risk variables present for each index admission.
MEASUREMENTS AND MAIN RESULTS: Nine high risk variables were identified. A risk index over three for all index admissions identified 54 (22.7%) of 238 readmitted patients versus 41 (6.5%) of 630 non-readmitted patients (P<0.0001 two-tailed Fisher's exact test, positive predictive value 0.568 & specificity 0.935). A risk index over two for multiple admission patients identified 56 (65.1%) of 86 readmitted patients versus 135 (40.7%) of 332 non-readmitted patients (P<0.0001 two-tailed Fisher's exact test, positive predictive value 0.651 & specificity 0.867). Over 30% of readmitted patients meeting risk index criteria were discharged home without organized home care. Sleep apnea, vertebral fractures and electrolytes and acid base disorders were newly identified predictors of readmission.
CONCLUSIONS: This study developed a risk index based upon our HRRP worksheet to explore risk variables predictive of 30 day readmissions in COPD patients at high risk for readmission (i.e PPR >0.4). Since most of the currently utilized interventions lack efficacy in preventing 30-day readmission, interventions based upon the newly identified variables should be validated with a larger validation cohorts. 342 words.
PMID: 26348091 [PubMed - as supplied by publisher]