Study: COPD Re-admissions Can Be Reduced

Re-hospitalization of patients with chronic obstructive pulmonary disease (COPD can be significantly reduced, according to a new sleep center study.

Writing in the Journal of Clinical Sleep Medicine Steven Coughlin, PhD, director of strategy, health economics and reimbursement at Philips Respironics, and colleagues described a multi-faceted approach used at one center.

The study was a retrospective look at a quality improvement (QI) program aimed at patients with COPD who had been hospitalized twice in a single year as a result of acute COPD exacerbation. Those patients were treated according to a multifaceted intervention plan that included:

● nocturnal administration of advanced positive airway pressure (PAP), or noninvasive positive pressure ventilation (NIPPV)

● medication reconciliation by a pharmacist

● adequate provision of oxygen

● patient education

● ongoing respiratory therapist-led care

There were 397 patients who met all of the eligibility criteria, and the proportion of patients who were readmitted the following year decreased by almost 80%, from 397 to 9. A total of 70 patients died during within one year of the initiation of the intervention.

The Centers for Medicare and Medicaid Services (CMS) has begun to track COPD-related rehospitalizations. In addition, the Agency of Healthcare Research and Quality (AHRQ) classifies COPD as a condition “for which good outpatient care can potentially reduce hospitalization, prevent complications, and reduce disease severity.” Although this study focused on only one quality improvement program and one sleep center, the authors say it provides enough information to warrant further research.

Some factors were associated with a higher risk of death or rehospitalization, namely inhaled corticosteroids and history of hypertension. However, inhaled antimuscarinics and previous PAP therapy were associated with a reduction of death or rehospitalization.

Two key differences in the QI program discussed in this study and previous programs that did not result in lower numbers of rehospitalizations was the use of nocturnal PAP or NIPPV and the respiratory therapist-led care that included home-visits. The researchers recommend future studies that encompass multiple centers as well as randomized, controlled trials.