Comprehensive Care Plan for Acute Exacerbations of COPD Proves Successful at Reducing Readmission, Mortality

The results of a recent study revealed that the implementation of a comprehensive care plan for acute exacerbations of chronic obstructive pulmonary disease (AECOPD) can be successful in reducing both readmission and mortality rates.

AECOPD is responsible for 50% to 75% of the $50 billion spent annually in the United States on COPD, study author Jill Ohar, MD, professor of Pulmonary, Critical Care, Allergy, and Immunology Medicine at Wake Forest Baptist Medical Center (WFBMC) in Winston-Salem, North Carolina, told MD Magazine®.

“The cost of readmission is 1.5 times the cost of original admission,” said Ohar. “There are also indirect costs of lost wages and productivity, along with the human suffering of hospitalization.”

In conjunction with the Affordable Care Act (ACA), the Center for Medicare & Medicaid Services (CMS) established a penalty for excess readmissions after a hospitalization for AECOPD. Numerous hospitals have established AECOPD reduction programs to comply with CMS requirements, according to WFBMC researchers, but few have actually shown improvements.

Most readmission reduction plans focus on improving transitions in care (between the hospital and home). But data show that enhancing transitional care, while important, rarely reduces readmission rates after a bout of AECOPD.

To further refine their care plan, the WFBMC team incorporated diagnosis and treatment of specific co-morbidities that are responsible for 50% of readmissions, diagnosis and treatment of COPD (only 30% of patients admitted for AECOPD have a pre-existing spirometric confirmation of their COPD), and the identification of patients that are in end-stage COPD in order to begin discussing end-of-life goals of care.

“One in 4 patients hospitalized for AECOPD will be dead in 1 year,” said Ohar. “When asked, nearly all state they would best like to spend that time in their home with family and friends.”

A total of 1274 participants were included in the study. All had AECOPD admissions occurring between May 12, 2014, and June 28, 2016. The participants were divided into the experimental group (AECOPD admissions treated according to the AECOPD care plan) and the control group (receiving usual care). To be included in the study, patients had to be 40 years of age or older, had an inpatient or observation hospital admission for more than 1 day, and a diagnosis code meeting the Agency for Healthcare Research and Quality (AHRQ) criteria for AECOPD.

Those AECOPD treated with the care plan saw a reduction in 30-day all cause readmission (odds ratio [OR] .84, 95% confidence interval [CI], .71 to .99), 30-day mortality (OR .63, 95% CI, .44 to .88) and combined all-cause readmissions and morality (OR .78, 95% CI, .67 to .92). AECOPD readmissions were also reduced at 90-days (OR .78, 95% CI, .63 to .96).

“Close attention to the details of good medical practice leads to a reduction in readmissions, mortality, and costs,” explained Ohar. “My experience tells me that programs such as ours are extremely labor intensive and take a huge effort to sustain, however, we don’t yet have data to support this.”

Cost of these programs, patient satisfaction, and reproducibility of the program at other institutions need to be explored, added Ohar.

The study, “A Comprehensive care plan that reduces readmissions after acute exacerbations of COPD,” was published online in Respiratory Medicine.