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Observational Study
. 2018 Aug:141:20-25.
doi: 10.1016/j.rmed.2018.06.014. Epub 2018 Jun 18.

A comprehensive care plan that reduces readmissions after acute exacerbations of COPD

J A Ohar  1 , C H Loh  2 , K M Lenoir  3 , B J Wells  3 , S P Peters  4
Affiliations
Observational Study

A comprehensive care plan that reduces readmissions after acute exacerbations of COPD

J A Ohar et al. Respir Med. 2018 Aug.

Abstract

Background: "Transitions of care" have been the focus of readmission reduction strategies for acute exacerbations of Chronic Obstructive Pulmonary Disease (AECOPD). Wake Forest Baptist Medical Center (WFBMC) implemented a comprehensive care plan for AECOPD admissions in 2014 that also seeks to improve the diagnosis/treatment of COPD, strives for the optimal management of co-morbidities, and emphasizes hospice/palliative care in appropriate patients.

Methods: A retrospective, electronic health record (EHR) based, observational cohort study was used to evaluate AECOPD admissions between 5/12/2014 to 6/28/2016. An existing AECOPD registry was used to determine care plan status, readmissions were identified from the EHR, and mortality information was obtained from the state of North Carolina. Propensity weighted, multiple logistic regression was used to compare the care plan (n = 597) versus usual care (n = 677) on readmission and mortality outcomes after covariate adjustment.

Results: Enrollment in the care plan was associated with a reduced odds of 30-day all-cause readmission (OR 0.84, 95% CI 0.71-0.99), 30-day mortality (OR 0.63, 95% CI 0.44-0.88), and the composite endpoint of 30-day, all-cause readmissions and mortality (OR 0.78, 95% CI 0.67-0.92). The plan also reduced AECOPD-specific readmissions at 90 days (OR 0.78, 95% CI 0.63-0.96).

Conclusion: A comprehensive care plan for patients hospitalized for AECOPD reduced the odds of all-cause readmission, mortality, and AECOPD specific readmission risk. This exploratory study reinforces the use of the AECOPD Care Plan at WFBMC. Future research should focus on a randomized, pragmatic clinical trial to further evaluate the impact of this plan on clinical outcomes.

Keywords: Chronic obstructive pulmonary disease; Electronic health records; Readmission; Respiratory therapy.

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Conflict of interest statement

Summary conflict of interest statements for each author

Chee Hong Loh, Brian J Wells, and Kristin M Lenoir have no disclosures.

Stephen P Peters has served as a consultant for Array Biopharma, AstraZeneca, Aerocrine, Airsonett AB, Boehringer-Ingelheim, Experts in Asthma, Gilead, GlaxoSmithKline, Merck, Novartis, Ono Pharmaceuticals, Pfizer, PPD Development, Quintiles, Sunovion, Saatchi & Saatichi, Sanofi Regeneron, Targacept, TEVA, and Theron. However, no financial support was received from these organizations for this study.

Jill A Ohar has served as a consultant to AstraZeneca, Novartis, Sunovion, BI, Mylan, Theravance, CSL Behring and receives compensation for these services. However, no financial support was received from these organizations for this study.

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