Risk assessment and rate of readmission within 30 days of discharge after hospitalization for acute exacerbation of chronic obstructive pulmonary disease

Özkan, Serir; Yılmaz, Celalettin; erer, onur fevzi

doi:10.5578/tt.20219705

Risk assessment and rate of readmission within 30 days of discharge after hospitalization for acute exacerbation of chronic obstructive pulmonary disease

Celalettin YILMAZ, (Sağlık Bilimleri Üniversitesi, İzmir Doktor Suat Seren Göğüs Hastalıkları ve Cerrahisi Eğitim ve Araştırma Hastanesi, Göğüs Hastalıkları Kliniği, İzmir, Türkiye)

Serir Aktoğu ÖZKAN, (Sağlık Bilimleri Üniversitesi, İzmir Doktor Suat Seren Göğüs Hastalıkları ve Cerrahisi Eğitim ve Araştırma Hastanesi, Göğüs Hastalıkları Kliniği, İzmir, Türkiye)

Onur Fevzi ERER (Sağlık Bilimleri Üniversitesi, İzmir Doktor Suat Seren Göğüs Hastalıkları ve Cerrahisi Eğitim ve Araştırma Hastanesi, Göğüs Hastalıkları Kliniği, İzmir, Türkiye)

Tüberküloz ve Toraks

2 1

Yıl: 2021 Cilt: 69 Sayı: 3 Sayfa Aralığı: 328 - 337 Metin Dili: İngilizce DOI: 10.5578/tt.20219705 İndeks Tarihi: 14-05-2022

Risk assessment and rate of readmission within 30 days of discharge after hospitalization for acute exacerbation of chronic obstructive pulmonary disease

Öz:

Introduction: Patients with chronic obstructive pulmonary disease (COPD) hospitalized for an exacerbation are at risk of early readmission for any reason within 30 days of discharge. Understanding the frequency and risk factors related to readmission can provide valuable input for the development of readmission reduction strategies. The aim of this study was to investigate the frequency, specific risk factors and the cost analysis of early readmission for any reason within 30 days after discharge of the patients hospitalized for acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Materials and Methods: In a prospective comparative case series study, 110 patients over 40 years of age who were hospitalized with AECOPD were included. The frequency of readmissions within 30 days of discharge after hospitalization for AECOPD was investigated. Those who were admitted to any hospital for any reason within 30 days after discharge were classified as the readmission group. Whereas nonhospitalized patients were defined as the nonreadmission group. Demographic, clinical, therapeutic, laboratory and financial data of the groups were evaluated. Results: Thirty-four (30.9%) COPD patients were readmitted during the first 30 days post index hospitalization. In multivariate analysis, the best predictors of early readmission were the low forced expiratory volume in one second (FEV1) predicted % (FEV1%) (OR= 0.961, %95 CI 0.927-0.997 p= 0.034) and COPD diagnosis time (OR= 0.908, %95 CI 0.838-0.983 p= 0.017). Mean length of stay of the second hospitalization was longer than both the readmitted and nonreadmitted groups (8.3, 8.1 and 7.8 days respectively). While mean cost of second hospitalization was 1189$, mean cost of index hospitalization of the readmission group was 794$ and that of index hospitalization of nonreadmission group was 582$. Conclusion: The frequency of readmissions within 30 days after discharge of the patients hospitalized for AECOPD are common and costly. Low FEV1 percentage and lower diagnosis time were found to be significant predictors for readmission within 30 days of the index hospitalization.

Anahtar Kelime:

Alevlenme nedeniyle hastaneye yatan kronik obstrüktif akciğer hastalarında taburcu olduktan sonraki 30 gün içerisinde hastaneye yeniden yatış risk faktörleri

Öz:

Giriş: Alevlenme nedeniyle hastaneye yatırılan kronik obstrüktif akciğer hastaları (KOAH), taburcu olduktan sonraki 30 gün içinde herhangi bir nedenle erken hastaneye geri yatış riski altındadır. Bu geri yatışlarla ilgili sıklık ve risk faktörlerinin anlaşılması, geri yatışları azaltmada bize rehber olabilmektedir. Bu çalışmanın amacı, KOAH alevlenme nedeniyle hastaneye yatırılan hastaların taburcu olduktan sonraki 30 gün içinde herhangi bir nedenle hastaneye geri yatış sıklığını, spesifik risk faktörlerini ve maliyet analizini araştırmaktır. Materyal ve Metod: Prospektif olan bu çalışmaya 40 yaş üstü KOAH alevlenme nedeniyle hastaneye yatırılan 110 hasta dahil edilmiştir. Hastalar taburcu olduktan sonraki 30 gün içinde yeniden hastaneye yatış durumuna göre iki gruba ayrılmıştır. Taburculuk sonrası 30 gün içinde tekrar hastane yatışı olanlar geri kabulü olan ("readmission") grup, tekrar hastaneye yatmayanlar geri kabul olmayan ("non-readmission") grup olarak tanımlanmıştır. Grupların demografik, klinik, tedavi, laboratuvar ve finansal verileri değerlendirilmiştir. Bulgular: Otuz dört (%30,9) KOAH hastasının taburculuk sonrası 30 gün içinde tekrar hastaneye geri yatışı olmuştur. Yapılan çok değişkenli analizde, erken geri yatışların en iyi göstergesi düşük FEV1% (OR= 0,961, %95 GA 0,927-0,997 p= 0,034) ve KOAH tanı süresidir (OR= 0,908, %95 GA 0,838-0,983 p= 0,017). İkinci hastanede yatışın ortalama süresi, geri kabulü olan grubun indeks yatışı ile geri kabulü olmayan grubun indeks yatışına göre daha uzun bulunmuştur (sırasıyla 8,3, 8,1 ve 7,8 gün). Tekrar hastaneye yatış maliyeti ortalama 1189$ iken, bu grubun indeks yatışındaki ortalama yatış maliyeti 794$ ve geri kabul olmayan grubun indeks hastane yatış maliyeti 582$’dır. Sonuç: KOAH Alevlenme nedeniyle yatarak tedavi olan hastalarda taburculuk sonrası 30 gün içinde tekrar hastaneye yatma durumu sıktır ve maliyetlidir. Düşük FEV1 yüzdesi ve KOAH tanı süresinin kısalığı, taburculuk sonrası 30 gün içinde yeniden hastane geri kabulü için önemli bir belirteç olarak bulunmuştur.

Anahtar Kelime:

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

1. Baker CL, Zou KH, Su J. Risk assessment of readmissions following an initial COPD-related hospitalization. International Journal of COPD 2013; 8: 551-9.
2. Shah T, Valerie G, Press VG, Huisingh-Scheetz, White SR. COPD Readmissions Addressing COPD in the Era of Value-based Health Care. Chest 2016; 150: 916-26.
3. Spece L J, Donovan L M, Griffith M F, Margaret P. Collins, Laura C, Feemster L C, Au D H. Quality of Care Delivered to Veterans with COPD Exacerbation and the Association with 30-Day Readmission and Death. COPD: Journal of Chronic Obstructive Pulmonary Disease 2018; 15: 489- 95.
4. Crisafulli E, Ortega S, Torres A. Predictors of Readmission in a Period of 30 Days or Less in Acute Exacerbation of Chronic Obstructive Pulmonary Disease. Clin Pulm Med 2015; 22: 172-6.
5. Chawla H, Bulathsinghala C, Tejada J. P, Wakefield D, ZuWallack R. Physical Activity as a Predictor of Thirty-Day Hospital Readmission after a Discharge for a Clinical Exacerbation of Chronic Obstructive Pulmonary Disease. Annals of the American Thoracic Society 2014; 11: 1203- 9.
6. Sharif R, Parekh T M, K S. Pierson K S, Kuo Y F, Sharma G. Predictors of early readmission among patients 40 to 64 years of age hospitalized for chronic obstructive pulmonary disease. Ann Am Thorac Soc 2014; 11: 685-94.
7. Jacobs D M, Noyes K, Zhao J, Gibson W, Murphy T F, Sethi S, Ochs-Balcom H M. Early hospital readmissions after an acute exacerbation of chronic obstructive pulmonary disease in the nationwide readmissions database. Ann Am Thorac Soc 2018; 15: 837-45.
8. Shah T, Churpek M, Perraillon M. C, Konetzka R T. Understanding Why Patients With COPD Get Readmitted. A Large National Study to Delineate the Medicare Population for the Readmissions Penalty Expansion. CHEST 2015; 147:1219-26.
9. Press V G, Au D H, Bourbeau J, Dransfield M T, Gershon A S et al. Feemster L C; on behalf of the American Thoracic Society Behavioral Science and Health Services Research, Clinical Problems, and Nursing Assemblies. Reducing Chronic Obstructive Pulmonary Disease Hospital Readmissions. An Official American Thoracic Society Workshop Report. Ann Am Thorac Soc 2019; 16: 161-70.
10. Simmering JE, Polgreen LA, Comellas AP, et al. Identifying patients with & COPD at high risk of readmission. Chronic Obstr Pulm Dis 2016; 3: 729-38.
11. Almagro P, Barreiro B Echagüen A O de, Quintana S, Carballeira M R, Heredia J LGarau J. Risk Factors for Hospital Readmission in Patients with Chronic Obstructive Pulmonary Disease. Respiration 2006; 73: 311-7.
12. Guerrero M, Crisafulli E, Liapikou A, Huerta A, Gabarrús A et al. Readmission for Acute Exacerbation within 30 Days of Discharge Is Associated with a Subsequent Progressive Increase in Mortality Risk in COPD Patients: A Long-Term Observational Study. PLoS One 2016; 11(3): e0150737.
13. Lau CSM, Siracuse BL Chamberlain RS. Readmission after COPD exacerbation scale: determining 30-day readmission risk for COPD patients. International Journal of COPD 2017: 12; 1891-902.
14. Alqahtani JS, Njoku CM, Bereznicki B, Barbara C. Wimmer BC, Peterson GM et al. Risk factors for all-cause hospital readmission following exacerbation of COPD: a systematic review and meta-analysis. Eur Respir Rev 2020; 29: 190166.
15. Singh G, ZhangnW, KuonY-F, Sharma G. Association of Psychological Disorders With 30-Day Readmission Rates in Patients With COPD. CHEST 2016; 149(4): 905-15.
16. Iyer A S, Bhatt S P, Garner J J, Wells J M, Trevor J L et al. Depression Is Associated with Readmission for Acute Exacerbation of Chronic Obstructive Pulmonary Disease. Annals ATS 2016; 13: 2.
17. Press VG, Konetzka RT, White SR. Insights about the Economic impact of COPD readmissions post implementation of the Hospital Readmission Reduction Program. Curr Opin Pulm Med 2018; 24(2): 138-46.
18. Stefan MS, Rothberg MB, Shieh M-S, Pekow PS, Lindenauer PK. Association Between Antibiotic Treatment and Outcomes in Patients Hospitalized With Acute Exacerbation of COPD Treated With Systemic Steroids. Chest 2013; 143; 82-90.
19. Zafar MA, Panos RJ, Ko J, Otten LC, Gentene A et al. Reliable adherence to a COPD care bundle mitigates system- level failures and reduces COPD readmissions: a system redesign using improvement science. BMJ Quality & Safety 2017; 26: 908-18.
20. Parikh R, Shah TG, Tandon R. COPD exacerbation care bundle improves standard of care, length of stay, and readmission rates. Int J Chron Obstruct Pulmon Dis 2016; 11: 577-83.
21. Ko FW, Ngai JC, Ng SS et al. COPD care programme can reduce readmissions and in-patient bed days. Respir Med 2014; 108: 1771-8.
22. Nguyen H Q, Chu L, Liu In-L A, Lee J S, Suh D et al. Associations between physical activity and 30-day readmission risk in chronic obstructive pulmonary disease. Ann Am Thorac Soc 2014; 11: 695-705.
23. Puhan MA, Gimeno-Santos E, Scharplatz M, Troosters T, Walters EH, Steurer J. Pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2011;10: CD005305.
24. Spruit MA, Singh SJ, Garvey C, ZuWallack R, Nici L et al. An Official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med 2013; 188: 13-64.
25. Jennings J H, Thavarajah K, Mendez M P, Eichenhorn M, Kvale P, Yessayan L. Predischarge bundle for patients with acute exacerbations of copd to reduce readmissions and ed visits. a randomized controlled trial. CHEST 2015; 147(5): 1227-34.
26. Adamson SL, Burns J, Camp PG, Sin DD, van Eeden SF. Impact of individualized care on readmissions after a hospitalization for acute exacerbation of COPD. International Journal of COPD 2016; 11: 61-71.
27. Bhatt S P, Wells J M, Iyer A S, Kirkpatrick deN P, Parekh TM et al. Results of a Medicare Bundled Payments for Care Improvement Initiative for Chronic Obstructive Pulmonary Disease Readmissions. Ann Am Thorac Soc 2017; 14: 643-8.
28. Ospina MB, Mrklas K, Deuchar L, Rowe BH, Leigh R et al. A systematic review of the effectiveness of discharge care bundles for patients with COPD. Thorax 2017; 72: 31-9.
29. Gupta A, Allen LA, Bhatt DL, Cox M, DeVore AD et al. Association of the Hospital Readmissions Reduction Program Implementation With Readmission and Mortality Outcomes in Heart Failure. JAMA Cardiol 2018; 3: 44-53.
30. Seemungal TA, Donaldson GC, Bhowmik A, Je ries DJ, Wedzicha JA. Time course and recovery of exacerba- tions in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2000; 161: 1608-13.

APA	Yılmaz C, Özkan S, erer o (2021). Risk assessment and rate of readmission within 30 days of discharge after hospitalization for acute exacerbation of chronic obstructive pulmonary disease. , 328 - 337. 10.5578/tt.20219705
Chicago	Yılmaz Celalettin,Özkan Serir,erer onur fevzi Risk assessment and rate of readmission within 30 days of discharge after hospitalization for acute exacerbation of chronic obstructive pulmonary disease. (2021): 328 - 337. 10.5578/tt.20219705
MLA	Yılmaz Celalettin,Özkan Serir,erer onur fevzi Risk assessment and rate of readmission within 30 days of discharge after hospitalization for acute exacerbation of chronic obstructive pulmonary disease. , 2021, ss.328 - 337. 10.5578/tt.20219705
AMA	Yılmaz C,Özkan S,erer o Risk assessment and rate of readmission within 30 days of discharge after hospitalization for acute exacerbation of chronic obstructive pulmonary disease. . 2021; 328 - 337. 10.5578/tt.20219705
Vancouver	Yılmaz C,Özkan S,erer o Risk assessment and rate of readmission within 30 days of discharge after hospitalization for acute exacerbation of chronic obstructive pulmonary disease. . 2021; 328 - 337. 10.5578/tt.20219705
IEEE	Yılmaz C,Özkan S,erer o "Risk assessment and rate of readmission within 30 days of discharge after hospitalization for acute exacerbation of chronic obstructive pulmonary disease." , ss.328 - 337, 2021. 10.5578/tt.20219705
ISNAD	Yılmaz, Celalettin vd. "Risk assessment and rate of readmission within 30 days of discharge after hospitalization for acute exacerbation of chronic obstructive pulmonary disease". (2021), 328-337. https://doi.org/10.5578/tt.20219705

APA	Yılmaz C, Özkan S, erer o (2021). Risk assessment and rate of readmission within 30 days of discharge after hospitalization for acute exacerbation of chronic obstructive pulmonary disease. Tüberküloz ve Toraks, 69(3), 328 - 337. 10.5578/tt.20219705
Chicago	Yılmaz Celalettin,Özkan Serir,erer onur fevzi Risk assessment and rate of readmission within 30 days of discharge after hospitalization for acute exacerbation of chronic obstructive pulmonary disease. Tüberküloz ve Toraks 69, no.3 (2021): 328 - 337. 10.5578/tt.20219705
MLA	Yılmaz Celalettin,Özkan Serir,erer onur fevzi Risk assessment and rate of readmission within 30 days of discharge after hospitalization for acute exacerbation of chronic obstructive pulmonary disease. Tüberküloz ve Toraks, vol.69, no.3, 2021, ss.328 - 337. 10.5578/tt.20219705
AMA	Yılmaz C,Özkan S,erer o Risk assessment and rate of readmission within 30 days of discharge after hospitalization for acute exacerbation of chronic obstructive pulmonary disease. Tüberküloz ve Toraks. 2021; 69(3): 328 - 337. 10.5578/tt.20219705
Vancouver	Yılmaz C,Özkan S,erer o Risk assessment and rate of readmission within 30 days of discharge after hospitalization for acute exacerbation of chronic obstructive pulmonary disease. Tüberküloz ve Toraks. 2021; 69(3): 328 - 337. 10.5578/tt.20219705
IEEE	Yılmaz C,Özkan S,erer o "Risk assessment and rate of readmission within 30 days of discharge after hospitalization for acute exacerbation of chronic obstructive pulmonary disease." Tüberküloz ve Toraks, 69, ss.328 - 337, 2021. 10.5578/tt.20219705
ISNAD	Yılmaz, Celalettin vd. "Risk assessment and rate of readmission within 30 days of discharge after hospitalization for acute exacerbation of chronic obstructive pulmonary disease". Tüberküloz ve Toraks 69/3 (2021), 328-337. https://doi.org/10.5578/tt.20219705