Next October, when COPD is added to the list of diagnoses for which hospital readmissions penalties are calculated, hospitalists will need to pay closer attention to comorbidities, home environments, socio-economic status, and other factors that can contribute to COPD readmissions.
This was a central theme at a recent conference on COPD and hospital readmissions sponsored by the COPD Foundation in Washington, D.C. The meeting brought together pulmonologists, policy makers, healthcare quality-improvement experts, and representatives from four national, patient-care transitions programs: the Care Transitions Program of the University of Colorado School of Medicine in Denver; Project RED (Re-Engineered Discharge) at Boston University Medical Center; the Transitional Care Model of the University of Pennsylvania in Philadelphia; and SHM's Project BOOST.
"This summit reinforces what has already been said, that there needs to be a comprehensive approach to COPD patients, not just managing the disease," said one of the conference’s key speakers, Mark Williams, MD, MHM, professor and chief of the division of hospital medicine at Northwestern University Feinberg School of Medicine in Chicago and principal investigator of Project BOOST. "Similar to heart failure, there needs to be support for the patient at home."
COPD is the third-leading cause of death in the U.S., with an estimated 15 million diagnosed patients and many more undiagnosed. One-fifth of hospitalized COPD patients are readmitted within 30 days, according to data from the Agency for Healthcare Research and Quality [PDF]. Many simultaneously present with heart disease, pneumonia, diabetes, or other comorbidities, and 62% of hospitalized COPD patients are readmitted for a condition other than COPD, says Brian Carlin, MD, senior staff physician at Allegheny General Hospital in Pittsburgh, Pa.
Preventing readmissions underscores the need for a patient-centered approach, says conference co-chair Jerry Krishnan, MD, PhD, professor of medicine and public health associate vice president for population health sciences at the University of Illinois Hospital and Health System in Chicago. "There's a tremendous amount of interest among physicians about the quality of care and health outcomes for these patients and conflicting evidence about what actually works," Dr. Krishnan says. "What works in one setting is unlikely to work in another setting."
Other physicians at the conference discussed ways hospitalists could help reduce COPD-related readmissions. Guidelines for non-pharmacologic interventions emphasize access to smoking cessation programs, immunizations for influenza, and pulmonary rehabilitation, says Byron Thomashow, MD, clinical professor of medicine at Columbia University Medical Center in New York City. "I also encourage all of my patients to exercise," he says.