Abstract
Background:
CMS Hospital Readmissions Reduction Program aims to reduce 30-d readmissions by encouraging hospitals to improve care coordination and communication between patients and care givers. Evidence has shown that COPD care bundles may be beneficial in reducing length of stay (LOS) and/or readmissions for a COPD exacerbation1. An interdisciplinary workgroup was created to research best practices and develop a new care bundle. A COPD order set had already been in place at this organization for several years. However, utilization was low at 31.68% (FY21) and in need of some improvements. Additionally, after a review of the literature it was identified key items were missing from our original order set that might be of benefit.
Methods:
A review was conducted of 6 studies that met certain criteria (quality, value, and ethical principles)2. An interdisciplinary workgroup had identified some gaps for patients that were being discharged with traditional inhalers. Issues included delays in receiving medication, drug cost, and failure to use proper technique. Studies have shown a high rate of inhaler misuse among hospitalized patients. Patients had their technique tested using AIM (Aerosol Inhaler Monitor) 58%, 52%, and 38% failed to use proper technique at the first, second, and third test, respectively3. So, in addition to standard order set items like O2, meds, ABG, etc, a novel concept was added to our orders to provide bedside education and a take-home kit. The free kit includes: albuterol, portable pocket neb, a COPD action plan and handbook. After several iterations of trial and error, a consistent process was implemented in April, 2023 by utilizing the outpatient pulmonary rehab therapist.
Results:
With increased focus on order set utilization, a 10% increase occurred by (FY24-March). Use of the order set helped ensure that COPD education was provided to 50% of the COPD order set group, with 39% receiving a take home kit. COPD payment reductions were issued by CMS for FFY22-24 for higher-than-expected readmission rates (16.23%-17.58%). Our CMS FFY25 and FFY26 (3 years of data) are projecting no payment reductions as rates have dropped to as low as 12.50%.
Conclusions:
Order set utilization is an important foundation to reducing LOS and readmissions for patients with COPD. Education, proper medication delivery technique, and a take home kit which includes a 30-d supply of medication are important items to consider adding to a COPD order set and may help to reduce COPD readmissions.
*These numbers were annualized due to incomplete year of reporting *CMS REPORTING: FFY is reflective of 3 fiscal years prior data. FFY25(7/1/20-6/30/23) & FFY26(7/1/21-6/30/24) View all access options for this article.Order Set Utilization
Fiscal Year
Order Set Utilization
FY22
42%
*FY23
53%
FY24-March
51.43%
Readmissions
Reporting Year
Readmission Rates
Penalty
FFY22-24
16.23%-17.58%
Yes
FFY25
16.28%
Maybe No
FFY26
12.50%
Projected No
Get full access to this article