Survey of COPD Readmission Prevention Practices and Related Outcomes in a Large Health System

Abstract

Background: The Centers for Medicare & Medicaid Services included COPD in the 30-day readmission penalty program starting in 2015. There has been intense interest in strategies to reduce readmissions. The Providence-St. Joseph Healthcare System is a large 51-hospital system across 7 states. The system utilizes a Respiratory Therapy Resource Council for system-wide initiatives, and in 2019 created a workgroup with the objective of reducing COPD readmissions. To understand the variety and effectiveness of different COPD related activities, the workgroup decided to survey the system to understand the effectiveness of local programs.

Methods: We created a 25-question survey on hospital practices aimed at reducing COPD readmissions. Survey was targeted towards respiratory therapy leadership, we reasoned this group would be the one most knowledgeable about their hospitals efforts. The draft of the survey was beta tested by 4 respiratory therapists with expertise in COPD and feedback was incorporated into final version. The survey was sent to RT leaders from April 1, 2019 to April 30, 2019 with weekly email reminders. After end of survey, outcomes data including COPD readmissions O/E, COPD readmission rates, Mortality O/E, and Length of stay was obtained from clinical analytics department via database search. Differences were determined by Mann-Whitney or Wilcoxon test where appropriate.

Results: The response rate was 37% (n=20), however many questions only had 17 responses. Common tactics to reduce COPD readmissions included proactively identifying COPD patients (76%), reviewing COPD Readmission (93.8), screening for severity (58.8%), tools to assess risk for readmission (58.8%). Less common were COPD navigators (23.5%), bundled COPD order sets (5.9%) and conducting home visits (17.6%). There were no statistically significant results with the exception of facilities which demonstrated a longer LOS for those using a COPD navigator (1.7 vs. 5.6, P= 0.0227). Results in Table 1.

Conclusions: PSJH utilizes a wide variety of COPD readmission reduction processes without clear evidence of a best practice. Further research and quality improvement indicatives will need to be conducted to establish best COPD readmission reduction strategies.