How to Predict and Prevent COPD Hospital Stays

Researchers have identified some predictors that may be used to assess the risk of rehospitalization of patients with chronic obstructive pulmonary disease (COPD).

The study, published in BMC Pulmonary Medicine on April 20. 2016, was conducted by Melissa H. Roberts PhD, of the Lovelace Clinic Foundations, and colleagues.

According to the researchers, COPD re-hospitalizations were estimated to cost $32.1 billion in 2010, and are expected to reach $49 billion by 2020. They say, “Hospitals are now keenly interested in identifying patients with COPD who are at highest risk for hospital readmission, and in finding interventions that reduce rehospitalization risk.”

The study was undertaken in order to identify factors from the index hospitalization in administrative claims or encounter databases that could indicate a risk of rehospitalization.

There were six points of interest:

· demographic factors;

· comorbid conditions in the pre-index period;

· use of COPD-related drugs in the pre-index period;

· COPD-related and all-cause healthcare utilization in the pre-index period;

· treatments during the index hospitalization; and

· office visits and antibiotic or oral steroid treatments in the month after the index hospitalization.”

In order to investigate, the researchers collected data from SDI Health, which in turn, collected data from national US claims clearinghouses and hospitals. The researchers conducted analyses on two sets of data. The first they called ‘the all-patient cohort,’ and it consisted of all eligible patients, and was used to investigate the predictors COPD-related rehospitalization. The second was called the ‘late cohort,’ and it did not include those patients who were readmitted to the hospital within 30 days of being discharged.

The researchers found that “patients who experienced a COPD-related rehospitalization differed from those who did not” on several variables, including smoking, existence of comorbidities, more frequent use of COPD-related drug therapies, more frequent hospitalizations for any reason. They report, “Pneumonia events and the use of antibiotics in the pre-index period were strongly associated with COPD-related rehospitalization.” There was also an association between the regular use of azithromycin and few exacerbations leading to hospitalization.

The researchers suggest that patients with a history of pneumonia or bronchitis should be monitored more closely to reduce rehospitalization rates, and that better adherence to COPD controller medicines could help lower rehospitalization rates. They conclude by saying further study into the parameters most strongly associated with re-hospitalization could be helpful in developing risk stratification systems and specific interventions.