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]
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. 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.
Medscape Pulmonary Medicine © 2015 WebMD, LLC
Cite this: Nicholas J. Gross. Reducing Readmission for Acute Exacerbation of COPD - Medscape - Mar 05, 2015.