Chest
Original Research: COPDUnderstanding Why Patients With COPD Get Readmitted: A Large National Study to Delineate the Medicare Population for the Readmissions Penalty Expansion
Section snippets
Data Sources
We used data from the Medicare Provider Analysis and Review file, which contains encounter information and patient demographics for all hospitalized fee-for-service beneficiaries. Data from California, Florida, Illinois, New York, Ohio, Pennsylvania, and Texas were chosen because they are geographically diverse and large regions; in 2006, these states contained 42.5% of the total Medicare population. Other demographics were obtained from the Master Beneficiary Summary File. This study was
Frequency of Index Admission and Readmission
Over the study period, there were 26,798,404 inpatient admissions to IPPS hospitals, and 947,084 were index COPD encounters (3.5%). There was a small but statistically significant increase (P < .0001) in the rate of admissions by year (Table 1). Patients were predominantly discharged to home without home care (60.4%) followed by home with home care (19.1%) and SNF (14.1%). A total of 191,698 (20.2%) index admissions resulted in readmission. The linear trend test revealed a small but
Discussion
To our knowledge, this study is the first to date to use a large Medicare dataset to evaluate beneficiaries admitted for COPD and readmitted under the HRRP COPD methodology. Only one-half of readmissions were due to respiratory causes. Readmitted patients had higher rates of dual enrollment, suggesting that readmission penalties may further increase penalties on safety net hospitals that typically care for dually enrolled patients. Finally, patients who used PAC were more likely to be
Acknowledgments
Author contributions: T. S. and R. T. K. had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. T. S. contributed to the study concept and design, study supervision, data analysis and interpretation, statistical analysis, drafting of the manuscript, and critical revision of the manuscript for important intellectual content; M. M. C. and M. C. P. contributed to the study concept and design, data analysis and
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Part of this article has been presented in abstract form at ATS 2014, May 16-21, 2014, San Diego, CA.
FUNDING/SUPPORT: This study was supported by the Agency for Healthcare Research and Quality [Grant AHRQ R21HS021877] and by a National Institutes of Health National Heart, Lung, and Blood Institute Research Training in Respiratory Biology [Grant T32 HL007605]. Dr Churpek has received grant support from the National Institutes of Health [K08 HL121080].
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