Improving the Care of Patients With COPD Using an Integrated Practice Unit and Bundled Payment Approach

Abstract

PURPOSE: Chronic obstructive pulmonary disease (COPD) is the 3rd leading cause of death in the United States and much of the disease-related morbidity and costs is due to acute exacerbations of COPD (AECOPD). Reducing AECOPD related hospitalizations and readmissions has become a focus for healthcare systems and the Centers for Medicare Services (CMS). We hypothesized that a multidisciplinary COPD Integrated Practice Unit (IPU) would reduce 90-day readmission rates for AECOPD. METHODS: In conjunction with a CMS Bundled Payment Pilot Project, the UAB Health System developed the COPD Integrated Practice Unit (IPU) to provide a multidisciplinary, coordinated approach to disease management. The approach involves a dedicated COPD team - including pulmonologists and a nurse practitioner as well as care managers, social workers, palliative care, pulmonary rehabilitation and home health. A COPD-IPU member receives notification of all AECOPD admissions by provider phone calls or an electronic medical record notification system. Coordination between the COPD-IPU team and the inpatient service occurs and post-discharge planning is implemented. At discharge, patients are given follow-up appointments in 3 to 14 days through the COPD-IPU clinic and receive post-discharge phone calls through a tele-nursing program once a week for four weeks. Any barriers to care or worsening or recurrence of symptoms are relayed to the COPD-IPU team for further intervention. RESULTS: From October 2011 to February 2012, prior to the implementation of the IPU, there were 238 AECOPD and 47 patients (19.6%) were readmitted within 30-days. After implementation of the COPD-IPU, there were 287 AECOPD between October 2012 and February 2013 and 46 patients (16.1%) were readmitted within 30 days. The absolute risk reduction for readmission was 3.5% (p=0.30). CONCLUSIONS: A multidisciplinary approach to managing hospitalized AECOPD may reduce the risk for readmission but more post-intervention data is required to confirm this benefit.