Reducing Readmissions in COPD

by admin | Oct 8, 2013

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

by admin | Aug 23, 2013

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...

Managing Acute COPD Exacerbations

by Physicians Weekly | Mar 13, 2013

The addition of antibiotics to regimens that include steroids for patients hospitalized with acute exacerbations of COPD appears to improve short-term outcomes. In a study, receipt of antibiotics was associated with a 40% reduction in in-hospital mortality risk and a 13% reduction in 30-day readmission for COPD when compared with no antibiotic administration. Abstract: Chest, January...

An Alternative Approach for COPD Screening

by Physicians Weekly | Oct 17, 2012

A staged COPD screening approach that includes a simple questionnaire and peak flow measurement appears to help detect clinically significant airflow obstruction disease sufferers. A study of 5,761 adults estimated that the tested approach achieved a sensitivity of 40.7% and specificity of 97.7%. Abstract: CHEST, August...

COPD in Patients Hospitalized With AMI

by Physicians Weekly | Sep 6, 2012

The gap in medical care between patients with and without COPD who are hospitalized with acute myocardial infarction (AMI) appears to have narrowed substantially between 1997 and 2007, according to Massachusetts researchers. However, those with COPD appear to be treated less aggressively and be at increased risk of adverse outcomes than those without COPD. In-hospital and 30-day mortality rates were 13.5% and 18.7% for those with COPD, compared with 10.1% and 13.2% rates for those without COPD, respectively. Outcomes did not improve over the 10 years studied despite increased use of evidence-based therapy for all patients with AMI. Abstract: Chest, June...

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