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    Top factors that predict 30-day COPD readmissions


    Readmission red flags

    WrightWrightJean Wright, MD, vice president of innovation for Charlotte, North Carolina-based Carolinas Healthcare System, notes that “only 30% of the patients who return within 30 days do so for a reason related to their primary COPD-related condition. Another reason may be a comorbid condition like congestive health failure (CHF) or chest pain.”

    Because these patients often have multi-comorbidity conditions, “keeping up with multiple medications, doctor's office appointments, and home care instructions is very difficult,” Wright says. “In fact, some of these patients have as many as 30 medications that they take in a 24-hour period. So it is not surprising that they cannot keep all these medications well managed.”

    Carolinas Healthcare recently found that the risk factors for readmission were demographic, high utilization, and disease specific. “For example, not surprisingly, if you were over 80, you were high risk,” Wright says. Likewise, “if you frequented an ER, urgent care, or had a previous admission last year, you were high risk.”

    The utilization measure might reflect the severity of the disease or lack of access to primary care, pulmonary care, or pulmonary rehabilitation, according to Wright. “Correlation does not conclude causality,” she says.

    Support strategies

    Wright says that support at the time of discharge, and follow up by telehealth for the first few days, “seems to make a difference in patients. We know getting back into their physician, particularly a pulmonologist, is a 'protective factor' against a readmission, but that must happen close to the index discharge to be of help to the patient.  Those first few days at home are critical to them continuing their course of recovery and for their medication regime to become routine.”

    Wright finds it interesting that male gender was a factor in the study.  For other conditions at her institution, “we find a higher risk of readmission for men who live alone. Perhaps the role of the helpful spouse reminding them of medication, treatments and appointments is a critical factor in avoiding a readmission.”




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