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Understanding why patients with COPD get readmitted: a large national study to delineate the Medicare population for
Tina Shah1, Matthew M Churpek1, Marcelo Coca Perraillon2
1Department of Pulmonary and Critical Care, The University of Chicago Medicine, The University of Chicago, Chicago, IL.
Insights
Most COPD readmissions are not for COPD itself, and reasons vary with post-acute care use. Dual Medicare-Medicaid enrollment is linked to higher readmission rates for COPD patients.
Area of Science:
- Health Services Research
- Pulmonology
- Health Economics
Background:
- The Hospital Readmissions Reduction Program (HRRP) penalizes hospitals for 30-day readmissions, including for Chronic Obstructive Pulmonary Disease (COPD) since 2014.
- Limited evidence exists on COPD readmission risk factors and reasons, hindering hospital intervention strategies.
Purpose of the Study:
- To investigate readmission risk factors and diagnoses for Medicare patients hospitalized with COPD.
- To analyze the impact of post-acute care (PAC) utilization on COPD readmissions.
Main Methods:
- Analysis of Medicare claims data from 2006-2010 across seven states.
- Identification of index COPD admissions using HRRP guidelines.
- Examination of patient demographics, readmission diagnoses, and PAC use.
Main Results:
- 3.5% of over 26 million inpatient admissions were for COPD, with a 30-day readmission rate of 20.2%.
- Respiratory diseases comprised half of readmissions; COPD was the most frequent diagnosis (27.6%).
- Patients discharged home without home care had higher COPD readmission rates (31.1% vs. 18.8%). Dual Medicare-Medicaid enrollment, longer hospital stays, and more comorbidities were associated with readmissions.
Conclusions:
- COPD exacerbation readmissions are often not for COPD, with reasons varying by PAC use.
- Dual Medicare-Medicaid enrollment is a significant factor in readmissions.
- Adding COPD to HRRP penalties may disproportionately affect safety net hospitals.
Background:
The Hospital Readmissions Reduction Program (HRRP) penalizes hospitals for 30-day readmissions and was extended to COPD in October 2014. There is limited evidence available on readmission risk factors and reasons for readmission to guide hospitals in initiating programs to reduce COPD readmissions.
Methods:
Medicare claims data from 2006 to 2010 in seven states were analyzed, with an index admission for COPD defined by discharge International Classification of Diseases, Ninth Revision, codes as stipulated in the HRRP guidelines. Rates of index COPD admission and readmission, patient demographics, readmission diagnoses, and use of post-acute care (PAC) were investigated.
Results:
Over the study period, there were 26,798,404 inpatient admissions, of which 3.5% were index COPD admissions. At 30 days, 20.2% were readmitted to the hospital. Respiratory-related diseases accounted for only one-half of the reasons for readmission, and COPD was the most common diagnosis, explaining 27.6% of all readmissions. Patients discharged home without home care were more likely to be readmitted for COPD than patients discharged to PAC (31.1% vs 18.8%, P < .001). Readmitted beneficiaries were more likely to be dually enrolled in Medicare and Medicaid (30.6% vs 25.4%, P < .001), have a longer median length of stay (5 days vs 4 days, P < .0001), and have more comorbidities (P < .001).
Conclusions:
Medicare patients with COPD exacerbations are usually not readmitted for COPD, and these reasons differ depending on PAC use. Readmitted patients are more likely to be dually enrolled in Medicare and Medicaid, suggesting that the addition of COPD to the readmissions penalty may further worsen the disproportionately high penalties seen in safety net hospitals.
