Prospective Cohort Study of Minority Inpatients With a Primary Discharge Diagnosis of COPD Exacerbation

Abstract

Background:

COPD exacerbations contribute to increased morbidity and mortality, and adversely affect patient quality-of-life. These events are also costly, and CMS is now penalizing hospitals for 30-d readmits related to COPD. Economic status will be included in the ratio calculation beginning FY 2019, which may help some hospitals avoid financial penalties. However, these adjustments may still be insufficient, so analyses of patient characteristics that may contribute to the incidence of COPD exacerbations and readmissions in specific populations is needed.

Methods:

Data were prospectively collected on a sample of patients admitted with a diagnosis of COPD exacerbations (N=107) (IRB 2570). Extensive interviews were conducted to include demographics, PMH, inhaled meds, insurance, and potential barriers to outpatient (OP) management. A DC-pharmacy data repository and CRISP were accessed to determine prescription refill behavior and readmission to any hospital, respectively. Using finance data, the subgroup with a J44.1 primary discharge code, COPD with exacerbation (n=49), was determined. Characteristics were summarized using descriptive statistics. Following univariate logistic regression, variables with a P <. 10 were entered into a multivariate model to determine factors independently related to readmission.

Results:

The average age of subjects coded J44.1 was 65.8 ± 9 y, 75% were female with 96% black; 47% had Medicare primary and 46% were dual eligible. Charleson comorbidity (CCM) averaged 5.2 ± 2.2, 43% reported currently smoking, 57% were on home O₂ and 57% had a psychiatric illness. Only 35% had an OP pulmonologist. The most common educational issues were health literacy and illness acuity. Subject-reported management barriers included lack of inhaler education (65%), no spacer (65%), lack of home support (50%) or transportation (50%), med costs (39%), and forgetting meds (28%). Pharmacy data indicated only 35% of subjects had a current refill of any long-acting inhaled med (LAIM) prior to admission, while 48% obtained a LAIM in the 10 d post discharge. 31% of subjects were readmitted, with the majority dual eligible. Univariate analysis showed only dual eligibility (P =.056) and CCM (P =.09) were significant, but entry in the multivariate model found no independent variables associated with readmission.

Conclusions:

Subjects discharged with J44.1 had a variety of health-based and social needs which may impact readmission. Discharge coding did not always reflect the top diagnosis listed in progress notes.

Table 1 shows the percent of subjects with variables that could potentially impact the development of a COPD exacerbation, or lead to hospital readmission. LAIM = Long-acting Inhaled Medication Med = Inhaled Medication Ed = Education