Chest
Volume 147, Issue 5, May 2015, Pages 1219-1226
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Original Research: COPD
Understanding Why Patients With COPD Get Readmitted: A Large National Study to Delineate the Medicare Population for the Readmissions Penalty Expansion

https://doi.org/10.1378/chest.14-2181Get rights and content

BACKGROUND

The Hospital Readmissions Reduction Program (HRRP) penalizes hospitals for 30-day readmissions and was extended to COPD in October 2014. There is limited evidence available on readmission risk factors and reasons for readmission to guide hospitals in initiating programs to reduce COPD readmissions.

METHODS

Medicare claims data from 2006 to 2010 in seven states were analyzed, with an index admission for COPD defined by discharge International Classification of Diseases, Ninth Revision, codes as stipulated in the HRRP guidelines. Rates of index COPD admission and readmission, patient demographics, readmission diagnoses, and use of post-acute care (PAC) were investigated.

RESULTS

Over the study period, there were 26,798,404 inpatient admissions, of which 3.5% were index COPD admissions. At 30 days, 20.2% were readmitted to the hospital. Respiratory-related diseases accounted for only one-half of the reasons for readmission, and COPD was the most common diagnosis, explaining 27.6% of all readmissions. Patients discharged home without home care were more likely to be readmitted for COPD than patients discharged to PAC (31.1% vs 18.8%, P < .001). Readmitted beneficiaries were more likely to be dually enrolled in Medicare and Medicaid (30.6% vs 25.4%, P < .001), have a longer median length of stay (5 days vs 4 days, P < .0001), and have more comorbidities (P < .001).

CONCLUSIONS

Medicare patients with COPD exacerbations are usually not readmitted for COPD, and these reasons differ depending on PAC use. Readmitted patients are more likely to be dually enrolled in Medicare and Medicaid, suggesting that the addition of COPD to the readmissions penalty may further worsen the disproportionately high penalties seen in safety net hospitals.

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].

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

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