Hospital-Level Factors Associated With Increased COPD Readmissions in the Medicare Population

Abstract

PURPOSE: Chronic Obstructive Pulmonary Disease (COPD) readmissions are associated with significant morbidity, mortality and excess cost to the healthcare system. In 2014 the centers for Medicare and Medicaid Services (CMS) instituted penalties for hospitals with excess COPD readmissions in an attempt to improve this outcome. We hypothesized that hospitals below the established COPD Readmission Benchmark from the Centers Medicare and Medicaid Services (CRBCMS) had specific factors that distinguished them from hospitals above the benchmark; the identification of these factors is an important step in the development of a comprehensive plan to decrease COPD readmissions. METHODS: Official data on healthcare indicators from the CMS were obtained from the hospital compare website (https://data.medicare.gov/data/hospital-compare). Hospitals above and below the CRBCMS were identified and data was extracted for these institutions. A comparison of hospitals above and below the CRBCMS was performed with nonparametric statistics. A -pvalue of <0.05 was considered statistically significant. RESULTS: Twenty-three hospitals were above and ninety hospitals were below the CRBCMS. Data was collected between 4/1/2010 to 9/30/2014. The median number of COPD readmissions was 80 in the group above vs 143 in the group below the CRBCMS (P<0.01). A strong correlation was seen between the CRBCMS and pneumonia (r=0.8, p=2.2×10-16). The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAPS) survey for institutions below the CRBCMS also showed lower indices of satisfaction in several components including nursing communication, assistance when needed, pain management, discharge instructions, understanding of discharge instructions and hospital rating. CONCLUSIONS: The CRBCMS identifies groups of hospitals with distinct characteristics including a strong correlation with pneumonia readmissions, suggesting the potential of a double diagnosis for these readmissions. Reports from the hospital consumer survey following hospitalizations in these institutions identify several differences that may be associated with systems issues independent of a COPD diagnosis. Prospective evaluation of these observations will inform the development of specific hospitallevel interventions to improve care and decrease COPD readmissions. CLINICAL IMPLICATIONS: Identifying factors that differentiate hospitals using the established CRBCMS provides an opportunity to engineer hospital systems to potentially decrease COPD readmissions.