The Centers for Medicare & Medicaid Services (CMS) started penalizing hospitals with “excess” 30-day readmissions, as determined by observed-to-expected ratio, for patients discharged after treatment for an acute exacerbation of chronic obstructive pulmonary disease (AECOPD). An understanding of modifiable determinants of 30-day readmission will likely help in developing interventions to reduce preventable AECOPD readmissions. Therefore, we examined the data of patients hospitalized with an AECOPD at our institution to identify the determinants of 30-day readmission.
Methods:
Data were obtained from University HealthSystem Consortium® (UHC®). We included patients (age >18 years) who were hospitalized with an AECOPD between 2011 and 2014. We extracted demographic, clinical, and financial information from medical records on all patients. Further, we identified patients who were readmitted within 30 days of hospital discharge. Comorbidity burden was assessed using Charlson Comorbidity Index. We compared patients readmitted within 30 days of hospital discharge with those who were not using logistic regression models without and with adjusting for potential confounding variables.
Results:
Of 686 patients admitted with an AECOPD, 54.8% were females, 63% were African Americans, 15% had Medicaid, 50% had Medicare, 80% were dual-enrolled in Medicare and Medicaid, 7.9% were self-pay, 10.5% were discharged home with home healthcare, mean (SD) age was 60 (53-69) years, and length of stay was 3 (2-6) days. Within 30 days of discharge, 123 (17.9%) were readmitted. Patients with or without readmission were similar in demographics and comorbidity burden with the exception of higher readmissions for patients receiving indigent care or enrolled in Medicaid (combined 26% in the readmitted vs. 22.2% in the control group; p=0.01). Median length of stay at index admission was longer for readmitted patients than those who were not (4 vs. 3 days, p=0.01). Additionally, patients were twice as likely to be readmitted if they were admitted from the Emergency Department on index admission (OR: 2.57, 95% CI [1.05-6.29], p=0.04). Patients discharged home with home health care were almost 3 times more likely to be readmitted than those discharged to a SNF or LTAC (OR 2.78, 95% CI [1.07-7.22], p=0.04).
Conclusions:
As compared to patients that were not readmitted, readmitted patients within 30-days following discharge after AECOPD hospitalization were more likely to have Medicaid or had received indigent care, had longer index-hospitalization length of stay, and were more likely to be discharged home with home health care. Patients with longer length of stay during index admission with AECOPD may benefit from discharge to another facility instead of home with home health care.