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2015 HSR&D/QUERI National Conference Abstract

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1031 — Organizational Factors and Risk of Readmission among Veterans Hospitalized for COPD

Rinne ST, VA CT Health Care System; Bastian LA, VA CT Health Care System; Wong ES, VA Puget Sound Health Care System; Hebert PL, VA Puget Sound Health Care System; Au DA, VA Puget Sound Health Care System; Kaboli PJ, Iowa City VA Health Care System; Cook MA, VA Puget Sound Health Care System; Liu CF, VA Puget Sound Health Care System;

Objectives:
With Center for Medicare and Medicaid Services expanding the Hospital Readmission Reduction Program, efforts are intensifying to reduce chronic obstructive pulmonary disease (COPD) readmissions. However, there is a lack of research identifying specific approaches to reduce these readmissions. We examined the association of organizational factors and risk for readmission among patients admitted for COPD to VA hospitals.

Methods:
In 2011, we conducted two nationwide surveys regarding acute medical services structure and COPD care at VA hospitals. From these surveys, we examined 22 organizational factors that we hypothesized to be related to COPD readmissions, including clinic structure, availability of standardized programs and protocols, and providers involved in patient care. The study sample included 26,308 patients who were admitted for COPD between 10/01/2009 and 9/30/2012 to 100 hospitals that responded to both surveys. The outcome was the 30-day COPD-specific readmission. We used a mixed-effect logistic regression to examine the association between organizational factors and readmission controlling for patient baseline characteristics, including demographics, comorbidities, and prior healthcare utilization.

Results:
Among the study patients, 2,459 were readmitted for COPD within 30 days of hospitalization (9.3%). After controlling for patient characteristics, factors associated with significantly reduced risk for readmission included having standardized patient education for COPD (OR = 0.85, 95% CI 0.75 - 0.95) and having hospitalists practice at the facility (OR = 0.83, 95% CI 0.72 - 0.96). Factors associated with increased risk for readmission included availability of pulmonary rehabilitation (OR = 1.13, 95% CI 1.01 - 1.26) and admitting more than 250 COPD patients per year (OR = 1.15, 95% CI 1.02 - 1.29).

Implications:
VA hospitals that reported having standardized patient education programs in the outpatient setting and having hospitalists were associated with a lower risk of readmissions for COPD, while larger hospitals and those that reported having a pulmonary rehabilitation program were associated with a higher risk of readmission.

Impacts:
Our results highlight the challenges that hospital systems face with limited and conflicting evidence on effective organizational factors to reduce hospital readmissions for COPD.