COMMENTARY

Reducing Readmission for Acute Exacerbation of COPD

Nicholas J. Gross, MD, PhD

Disclosures

March 05, 2015

The Association Between Hospital Readmission and Pulmonologist Follow-up Visits in Patients With Chronic Obstructive Pulmonary Disease

Gavish R, Levy A, Dekel OK, Karp E, Maimon N
Chest. 2015 Jan 22. [Epub ahead of print]

Study Summary

Acute exacerbations of chronic obstructive pulmonary disease (AECOPDs), are serious events that have an unfavorable impact on the long-term clinical course of patients with chronic obstructive pulmonary disease (COPD), besides being very expensive. When a patient experiences an AECOPD, the risk for recurrence is highest within a few weeks. Health insurance companies and the Centers for Medicare & Medicaid Services (CMS) are attempting to prevent readmissions by reducing reimbursement payments to hospitals with "excessive" readmissions for AECOPD.[1] One strategy used to prevent readmission for AECOPD is the administration of medications. Another is prompt follow-up of these patients after discharge from the hospital. Gavish and colleagues recently examined the impact of follow-up visits on the readmission rates of patients who experienced AECOPD.

In a retrospective analysis of all patients admitted for AECOPD to a lung institute in Israel over the course of 7 years, the investigators determined the risk for readmission for the same diagnosis as a function of whether a follow-up visit occurred and the timing of that visit. Of the 195 patients in the study, 44% made follow-up visits within 30 days of discharge. The remainder (56%) did not undergo a follow-up visit within that time frame. The primary outcome—relative risk for recurrence of AECOPD within 90 days of the previous AECOPD—was significantly higher in patients who did not make a follow-up visit within 30 days of discharge. The relative risk for AECOPD with no follow-up vs one or more follow-up visits within 30 days of discharge was 2.91 (95% confidence interval: 1.06-8.01). Nonattendance at a follow-up visit was independently associated with greater distance of the patient's residence from the clinic, higher number of exacerbations in the previous year, failure to attend previous follow-up visits, and lack of a discharge letter to the primary caregiver. The investigators concluded that early follow-up with a pulmonologist may reduce the risk for rehospitalization for AECOPD.

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