COPD Hospital Readmissions Penalties: Do Patients Discharged with COPD diagnoses have COPD?

Au DH, Berger D, Carvalho P, Collins MP, Goodman R, Gunnink E, McDowell J, Moss B, Nelson KM, Plumley R, Reinke LF, Weppner W, Woo D, Feemster LM. COPD Hospital Readmissions Penalties: Do Patients Discharged with COPD diagnoses have COPD? Poster session presented at: American Thoracic Society Annual International Conference; 2015 May 20; Denver, CO.

Related HSR&D Project(s)

• IIR 12-130 – Integrating Care After Exacerbation of COPD (InCasE)

Abstract Body Background and Objective This year, the Centers for Medicare and Medicaid Services (CMS) Hospital Readmission Reduction Program (HRRP) included penalties for hospitals with excessive chronic obstructive pulmonary disease (COPD) readmissions. We sought to examine whether patients discharged from hospital with a COPD diagnosis had spirometric results consistent with COPD. Methods We performed a cross-sectional study of patients who had been discharged from one of two Department of Veterans Affairs (VA) facilities in the Pacific Northwest between January 2014 and December 2014. Data was assessed from VA electronic medical records and through chart abstraction. Patients were considered to have a COPD discharge if they had received a primary discharge diagnosis of COPD or had a primary discharge diagnosis of acute respiratory failure and a secondary diagnosis of COPD. Our primary outcome was whether patients had evidence of COPD, including past spirometry and spirometric values consistent with COPD using GOLD guidelines. We examined predictors of having airflow obstruction using logistic regression. Results We identified 189 patients who were discharged with a COPD exacerbation of which 137 (72.4%) had a primary discharge diagnosis of COPD and 52 (27.6%) had primary diagnosis of respiratory failure and a secondary diagnosis of COPD. Of the total, 84.7% (160/189) had history of having had spirometry performed and among those, 80.0% (128/160) had airflow obstruction using GOLD criteria. Collectively, only 67.8% (128/189) of patients had documented spirometric evidence of COPD. Among patients with spirometric values who had normal weight or greater, higher BMI was associated with lower odds of having COPD (BMI 30-34.9 OR:0.65 (0.22- 2.03), BMI > = 35 OR:0.21 (0.081-0.54)). No other variables were associated with spirometric confirmation of COPD including Charlson comorbidity score, receipt of NIPPV, and having a primary care provider. In a sample of patients discharged with a primary discharge diagnosis of COPD, all had treatments consistent with a COPD exacerbation. Among patients who had a primary diagnosis of respiratory failure and a secondary diagnosis of COPD exacerbation, 8.6% (3/35) did not have treatments consistent with a COPD exacerbation based on chart abstraction. Conclusion As many as one in three patients discharged from hospital with a diagnosis of COPD exacerbation may not actually have COPD.