Centers for medicare services and copd

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Higher COPD readmission rates were associated with lower scores for communication with nurses Higher readmissions were also associated with a lower overall rating of the hospital Differences in patient experiences were also evident when comparing the proportion of hospitals that did not meet the Achievement threshold for multiple domains, including communication with doctors We found significant associations between COPD readmissions and other quality measures, including readmissions for other medical conditions and measures of patient experience.

These associations suggested that common organizational factors might influence multiple clinical outcomes. As health systems transition to value-based reimbursement models, understanding the relationship between different quality measures could help broaden efforts to improve the overall quality of patient care. With increasing attention on COPD readmission rates, there is debate about whether this measure is a valid marker of hospital quality Despite a comprehensive examination of patient and hospital characteristics that affects COPD care, few factors have been associated with reduced readmission or mortality In this study, we were not able to assess the cause of COPD readmissions or whether they were preventable.

However, our results did show notable variation in COPD readmission rates across hospitals, and this metric was associated with other measures of hospital quality. These findings suggested that organizational factors that led to better quality based on patient experience and readmission rates for other medical conditions also reduced COPD readmissions.

Additional research is needed to identify the common structural, cultural, and behavioral factors that affect these similar quality measures. We identified significant correlations between COPD readmission rates and readmission rates for other conditions.

Although correlation coefficients were not high for any of the comparisons all correlation coefficients were less than 0. Horowitz and colleagues identified similar correlations between HF, AMI, and pneumonia readmission rates, although they did not examine readmission rates for COPD or surgical conditions Our findings indicated that organizational factors that affected disease-specific readmissions likely had a more widespread effect across medical conditions, although surgical conditions might require a different approach.

Patients with chronic medical disease tend to have multiple comorbidities, and treatment guidelines are beginning to appreciate the need to address multimorbidity One concern about the effects of HRRP has been that these two outcomes represent competing interests, and reductions in readmissions may increase mortality Krumholz and colleagues examined the association between hospital readmission rates and mortality for HF, AMI, and pneumonia, and found minimal to no correlation between the outcomes 9.

To our knowledge, a similar analysis has not been conducted for COPD. Although few studies showed that efforts to reduce COPD readmissions were associated with increased mortality, others showed that intensive outpatient management of COPD exacerbations could reduce readmissions without increasing mortality 27 , Our results were consistent with the evidence that readmission rates are not associated with mortality for COPD, although we did not know what impact implementation of HRRP has had on this relationship.

There also were no significant associations between COPD readmission and mortality from other conditions. Many of the organizational factors that affect readmissions are likely to differ from organizational factors that affect mortality 9. Reported readmission rates focus on the 30 days after hospital discharge, whereas mortality rates focus on the 30 days after hospital admission and include the hospitalization Because a substantial proportion of deaths for selected conditions occur during the index hospitalization, greater attention to inpatient care is likely to yield lower mortality, whereas improving readmission rates requires more attention on the postdischarge period 1 , To promote organizational characteristics that affect mortality, CMS adopted the Hospital Value-Based Purchasing Program, a pay-for-performance program that incentivizes hospitals based on multiple performance measures that reflect inpatient care, including day mortality for AMI, HF, and pneumonia Although the differences in linear scores across readmission quartiles were small, associations with the lack of Achievement scores indicated that these differences could affect hospital reimbursement.

The largest difference in patient experience between high readmission hospitals versus low readmission hospitals occurred with responses related to whether or not patients would recommend the hospital. There is extensive literature on the association between patient satisfaction and quality of care Although some have argued that patients may not be qualified to effectively judge their care, our findings suggested that patients tended to recommend higher quality hospitals with respect to COPD readmissions Many of the HCAHPS domains focus directly on patient care that could influence readmission, such as communication and discharge information.

These domains are integral components of some of the few organizational efforts that have been shown to reduce COPD readmissions, such as integrated disease management programs and patient education programs 34 , Other elements of patient experience were also associated with COPD readmissions in our study, such as cleanliness and quietness of the hospital.

These domains might reflect an underlying organizational emphasis on patient-centered care that creates a culture of quality. Previous studies found inconsistent relationships between patient experience and clinical outcomes 11 , 36 — Studies on surgical readmissions were less clear, with some studies demonstrating an association between experience and readmission and others showing no association 37 , To our knowledge, previous research has not examined the association between patient experience and COPD readmissions.

Our findings add to the literature and suggest that more patient-centered care is associated with better quality for patients who are hospitalized with COPD. It is notable that COPD readmission rates in our study differed by hospital type. There were higher readmission rates in teaching and safety net hospitals. These hospitals tend to care for more vulnerable and complex patient populations, and are more likely to be penalized in pay-for-performance models; risk-adjustment methods might not completely account for the medical and socioeconomic challenges affecting their patient populations 40 — We also identified higher readmission among private, for-profit hospitals.

Hospitals during this time did not have a financial incentive to reduce readmissions, and many hospitals benefitted from increased healthcare use 1. After implementing HRRP, HF readmission rates declined for all types of hospitals, including private for-profit systems A potential limitation of this study was that the risk-adjustment methods we relied on might not completely control for the severity of the medical, socioeconomic, and environmental factors that affect readmissions.

Nevertheless, the methods are being used to penalize hospitals under HRRP, and they were validated in previous studies 45 , At the same time, studying these relationships before adoption of HRRP limited the potential impact of hospitals gaming the system to avoid financial penalties The period represented by the data included the time in which HRRP was implemented for other medical conditions. The quality metrics presented on the Hospital Compare website are composite measures for the 3 previous years, and we were not able to isolate yearly readmission rates to examine trends.

Although our study suggested that common organizational factors might affect multiple quality metrics, we were unable to identify which of these factors influenced outcomes among hospitals in our study. Although there continues to be limited data on how to effectively reduce COPD readmissions, results of this study demonstrated that COPD readmissions are associated with readmissions for other medical conditions and domains of patient experience. These findings implied that common organizational factors might affect multiple disease-specific outcomes and the overall quality of healthcare.

With most financial incentives focused on individual quality metrics, hospitals might miss an opportunity to more broadly implement common elements of quality. As researchers, regulators, and hospital administrators search for methods to improve hospital quality, understanding the organizational factors that are common to different disease outcomes might help identify high-yield interventions to improve patient care.

Francis fellowship S. Author Contributions: S. Study concept and design: S. Drafting of the manuscript: S. Statistical analysis: S. Study supervision: S. Acquisition, analysis or interpretation of data: all authors. Critical revision of the manuscript for important data: all authors. Author disclosures are available with the text of this article at www. Published online Jul 1. Seppo T. Rinne , 1, 2 Jose Castaneda , 3 Peter K. Lindenauer , 4, 5 Paul D. Cleary , 6 Harold L.

Paz , 7, 8 and Jose L. Gomez 8. Peter K. Paul D. Harold L. Paz 7 Aetna, Inc. Jose L. Author information Article notes Copyright and License information Disclaimer. Corresponding author.

Correspondence and requests for reprints should be addressed to Jose L. Gomez, M. E-mail: ude. Received Sep 27; Accepted Jan Abstract Rationale: The Centers for Medicare and Medicaid Services recently implemented financial penalties to reduce hospital readmissions for select conditions, including chronic obstructive pulmonary disease COPD.

Keywords: chronic obstructive pulmonary disease, patient readmission, quality indicators, health care. At a Glance Commentary Scientific Knowledge on the Subject Despite increasing focus on hospital performance measures, limited research has examined associations between quality measures. Methods We analyzed data from the CMS annual files downloaded from the Hospital Compare website to examine the association between COPD readmission rates and other measures of hospital quality Hospital Characteristics We identified hospital characteristics, including ownership, teaching status, and safety net designation.

Table 1. Open in a separate window. Hospitals were divided into quartiles based on COPD readmission rates. Readmissions There was significant correlation between COPD readmission rates and readmission rates for other conditions Figure 1. Figure 1. Figure 2. Table 2. Figure 3. Discussion We found significant associations between COPD readmissions and other quality measures, including readmissions for other medical conditions and measures of patient experience.

Conclusions Although there continues to be limited data on how to effectively reduce COPD readmissions, results of this study demonstrated that COPD readmissions are associated with readmissions for other medical conditions and domains of patient experience.

References 1. Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med. Medicare program; hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system and fiscal year rates; quality reporting requirements for specific providers; reasonable compensation equivalents for physician services in excluded hospitals and certain teaching hospitals; provider administrative appeals and judicial review; enforcement provisions for organ transplant centers; and electronic health record EHR incentive program: final rule.

Fed Regist. Shurin S. Morbidity and mortality chart book on cardiovascular, lung, and blood diseases. The clinical and economic burden of chronic obstructive pulmonary disease in the USA. Clinicoecon Outcomes Res. Deaths: final data for Natl Vital Stat Rep. Published September 2, Adjusting for COPD severity in database research: developing and validating an algorithm. Rising costs of COPD and the potential for maintenance therapy to slow the trend.

Am Health Drug Benefits. Adherence to inhaled therapy, mortality and hospital admission in COPD. Published May 1, Accessed January 21, Sign in. Cancer Care Business Exchange. Journal of Clinical Pathways. Current Issue. Author Guidelines. Special Reports. Submit a Manuscript. Latest News. Elsevier Partner Spotlight. Oncology Innovations.

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About the Journal. Advertising Information. Editorial Advisory Board. Editorial Team. Contact Us. Flavia Ejzykowicz, PhD. Keywords chronic obstructive pulmonary disease. Log in or register to view. Copied to clipboard. Key Words: chronic obstructive pulmonary disease, beta agonists, Medicare, health care costs, health care utilization Citation: Journal of Clinical Pathways. Received February 23, ; Accepted March 28, Study Design. Submit Feedback. Email Address. This review summarizes the diagnosis, pathophysiology, and evidence-based guidelines for the prevention and management of tumor lysis syndrome, a common, acute, life-threatening disease primarily in patients with hematologic cancers and solid This review summarizes the In an interview with Journal of Updated multiple times in , The Journal of Clinical Pathways convened the Care Pathways Working Group to identify and reconcile the different pathway drivers for each stakeholder now and five years into the future, creating a framework tool based on oncology care The Journal of Clinical Pathways NCCN released updates to its practice guidelines on treating triple-negative breast cancer, featuring updates on sacituzumab govitecan recommendations and more.

NCCN released updates to its New Approved Treatments and Indications in Oncology. This article was developed by Clinical Pathways. Infectious Diseases. Population Health. Wound Care.

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