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    Top factors that predict 30-day COPD readmissions


    Among the risk factors for 30-day hospital readmission for chronic obstructive pulmonary disease (COPD) are old age, male sex, longer hospital stay, prior hospitalizations, previous emergency department visits, leaving the hospital against medical advice, being discharged home with support services, and a more severe comorbidity.

    In addition, patients of low socioeconomic status, those who are the most marginalized members of society, are also more likely to be readmitted than those patients who are prosperous and stable. 

    These are the findings of a population-based longitudinal cohort study conducted in Ontario, Canada.

    All hospitalizations for COPD between 2004 and 2014 were assessed in 130,137 patients, of whom 15% had an unplanned readmission, with the median time to readmission being 12 days.

    “Some of our results, such as prior hospitalizations and more severe comorbidity, are consistent with previous studies, so this is reassuring and makes us feel that we are on the right track,” says lead author Andrea Gershon, MD, a pulmonologist at Sunnybrook Health Sciences Centre in Toronto, Canada.

    Study results were published as an abstract and presented in May at the American Thoracic Society 2017 International Conference in Washington, D.C.

    Readmission reduction strategies

    “Unfortunately, socioeconomic factors that have been present for years and years are highly ingrained and not easy to address,” Gershon says. “Perhaps this is a signal to us that we need to start tackling these factors earlier, and not just after a patient’s first hospital admission.”

    Ensuring that a patient adheres to their medication regimen is one strategy to reduce readmission. “Making medication affordable is important,” Gershon says. “Housing issues and unemployment are also issues that might need addressing.”

    Smoking cessation is another factor that is more common in people of lower socioeconomic status.

    “In our study, which took place in Canada where healthcare is universal, it is unlikely that the cost of health services or insurance was the reason for the disparity due to socioeconomic status that we saw,” Gershon says.

    One of the predictors of readmission that was not very intuitive is specialist care. “This is probably due to specialists taking care of patients with the most severe disease,” Gershon says.

    Next: Readmission red flags



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