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Reducing Readmissions in COPD

Reducing Readmissions in COPD

Throughout the United States, more patients are being diagnosed with and treated for COPD than ever before, and many are unaware they even have the disease. COPD ranks as the third most frequent cause for readmission to hospitals within 30 days. Beginning in October 2015, Medicare reimbursement will be reduced for acute care hospitals whose rates for COPD readmission exceed a predetermined threshold. “The new Medicare reimbursement issue that withholds remuneration to hospitals for COPD exacerbation recidivism compels physicians to improve COPD care,” says Reynold A. Panettieri, Jr., MD. In light of the potential financial penalties from this decree, hospitals are committing substantial resources to developing systems and programs that are designed to mitigate readmissions. It can be exceptionally challenging for clinicians to assure the stability of COPD after patients are discharged from hospitals. In order to prevent COPD-related rehospitalizations, clinicians need a clear understanding of the causes of patient decompensation that lead to readmission and then find ways to diminish these causes. Several factors have been shown to be predictive of readmission in clinical studies. These include prior hospital admission, oral corticosteroids, use of long-term oxygen therapy, poor health-related quality of life, and a lack of routine physical exercise. Interventions to Prevent COPD Readmissions In recent years, strategies for preventing readmissions in patients with COPD have been the focus of many clinical investigations. Many interventions have been explored, including face-to-face, post-discharge educational visits, patient education initiatives, and telephone follow-up. These interventions—and many others—have had varied success, but some common themes have emerged. For example, hospitals with more respiratory consultants and better organized care have lower mortality rates and...
A Look at Recidivism in COPD Management

A Look at Recidivism in COPD Management

COPD is a group of progressively debilitating respiratory conditions, including emphysema and chronic bronchitis, and it ranks as the third leading cause of death in the United States, according to the CDC. About 16 million Americans are currently diagnosed with COPD, but another 14 million or more remain undiagnosed. In addition, COPD accounts for nearly 2 million ED visits each year, but much of this data is confounded by asthma admissions. “COPD patients who require ED attention or hospitalization are those with the most severe disease,” explains Reynold A. Panettieri, Jr., MD. “Furthermore, hospitalization and ED visits for COPD are more often clustered in the winter. They are associated with exposure to viruses and bacterial pathogens.” People aged 50 and older are more likely than others to get COPD, but the damage starts years before these individuals are diagnosed and can progress even after smoking cessation. Since the disease occurs and is diagnosed later in life, the risk of COPD is especially high for patients older than 45 with a smoking history. Healthcare Utilization & Readmission for COPD Most patients with diagnosed COPD report that symptoms of their disease impair their quality of life, but only about half take at least one daily medication for COPD. The healthcare utilization rate for COPD patients is also substantial. About one in five COPD patients visits an ED or is admitted to a hospital for care within a year. “The bottom line is that patients, providers, and the healthcare system cannot afford recidivism for COPD hospitalization.” Recidivism in healthcare has been defined as the tendency by ill patients to relapse or return...

Reducing Exacerbations in COPD

COPD has vaulted to the third-leading cause of death in the United States and continues to tax healthcare systems nationwide. The disease is complicated by frequent and recurrent acute exacerbations, which result in high morbidity and substantial healthcare expenditures. Exacerbations of COPD result in more than 100,000 deaths and over 500,000 hospitalizations each year (Figure 1). There is also a large economic burden associated with the medical care that is required for these patients. Exacerbations are the largest direct cost for the treatment of COPD. A major component to the overall cost is hospitalizations, which represent more than half of the total costs relating to the disease. In addition to the financial burden of treating these patients, other costs, such as days missed from work and severe limitations in quality of life, are important features of COPD. Exacerbations have been defined as events in the natural course of COPD that are characterized by changes in baseline dyspnea, cough, and/or sputum that go beyond normal day-to-day variations. They are acute in onset and may warrant changes in regular medication. Patients with COPD will likely experience symptoms of the disease on an ongoing basis, making it challenging for clinicians to know if the symptoms are part of day-to-day life or signs of a true exacerbation. “The key is to look for symptoms that are worse than usual,” says Reynold A. Panettieri, Jr., MD. “Unfortunately, exacerbations can occur even when patients are doing everything in their power to prevent them, including getting appropriate vaccinations, taking steps to avoid infections, and using medications as prescribed.” Develop an Action Plan for COPD Physicians who...
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