The Centers for Medicare and Medicaid Services limit payments to hospitals with high readmission rates for patients admitted with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). COPD remains the third most common cause of readmission among Medicare beneficiaries, occurring in 60% of patients within one year of hospital discharge and in 30% within three months of discharge. Decreasing readmissions in this patient population improves patient health and decreases health care utilization of resources. We hypothesized a COPD care bundle delivered by a multidisciplinary health care team in conjunction with a follow-up appointment made before discharge would reduce readmission rates for AECOPD.
A retrospective cohort design study with pre- and post-intervention arms was conducted. From September 2018 to December of 2018, patients admitted with AECOPD at two small community hospitals were enrolled in the pre-intervention group. Subsequently, an evidence-based COPD care bundle was developed with three primary objectives: patient education on COPD by health care providers before discharge, completion of an individualized self-management COPD action plan to be used by patients after hospital discharge, and timely outpatient follow-up with a pulmonologist or primary care provider. After this COPD care bundle was implemented in May of 2019, patients admitted with AECOPD from May 2019 to October 2019 were placed in the post-intervention group. Patient characteristics, hospital length of stay (LOS), discharge location, and readmission rates for both groups were collected. The primary outcome was decreasing 30-day readmission rates.
The pre-intervention group contained data from 315 COPD patients from September 2018 to December 2018 and had a 30-day readmission rate of 38.1%. The post-intervention group included 127 patients admitted from May 2019 to October 2019 and had a 30-day readmission rate of 18.9%. From a 38.1% readmission rate in 2018 to an 18.9% readmission rate in 2019. This yielded a 49.6% reduction in readmissions with a p
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MSN, RN, CMSRN, NPD-BC,
Hackettstown Medical Center