Evaluation of prediction strategy and care coordination for COPD readmissions.
Hosp Pract (1995). 2016 Jul 7;
Authors: Bashir B, Schneider D, Naglak MC, Churilla TM, Adelsberger M
Abstract
OBJECTIVES: Factors that influence the likelihood of readmission for chronic obstructive pulmonary disease (COPD) patients and the impact of posthospital care coordination remain uncertain. LACE index (L=length of stay, A=Acuity of admission; C=Charlson comorbidity index; E=No. of emergency department (ED) visits in last 6 months) is a validated tool for predicting 30-days readmissions for general medicine patients. We aimed to identify variables predictive of COPD readmissions including LACE index and determine the impact of a novel care management process on 30-day all-cause readmission rate.
METHODS: In a case-control design, potential readmission predictors including LACE index were analyzed using multivariable logistic regression for 461 COPD patients between January-October 2013. Patients with a high LACE index at discharge began receiving care coordination in July 2013. We tested for association between readmission and receipt of care coordination between July-October 2013. Care coordination consists of a telephone call from the care manager who: 1) reviews discharge instructions and medication reconciliation; 2) emphasizes importance of medication adherence; 3) makes a follow-up appointment with primary care physician within 1-2 weeks and; 4) makes an emergency back-up plan.
RESULTS: COPD readmission rate was 16.5%. An adjusted LACE index of ≥ 13 was not associated with readmission (p=0.186). Significant predictors included female gender (odds ratio [OR] 0.51, 95% confidence interval [CI] 0.29-0.91, p=0.021); discharge to skilled nursing facility (OR 3.03, 95% CI 1.36-6.75, p=0.007); 4-6 comorbid illnesses (OR 9.21, 95% CI 1.17-76.62, p=0.035) and ≥ 4 ED visits in previous 6 months (OR 6.40, 95% CI 1.25-32.87, p=0.026). Out of 119 patients discharged between July-October 2013, 41% received the care coordination. The readmission rate in the intervention group was 14.3% compared to 18.6% in controls (p=0.62).
CONCLUSIONS: Factors influencing COPD readmissions are complex and poorly understood. LACE index did not predict 30-days all-cause COPD readmissions. Posthospital care coordination for transition of care from hospital to the community showed a 4.3% reduction in the 30-days all-cause readmission rate which did not reach statistical significance (p=0.62).
PMID: 27391991 [PubMed - as supplied by publisher]