ATS 2021 Abstracts Identify Factors Influencing Hospitalization Risks for COPD

Two abstracts presented at the ATS 2021 International Conference examined the events that delay patients from seeking care and the methods used to aid hospitals in preventing readmissions for patients with chronic obstructive pulmonary disease (COPD).

Underlying Decisions Leading to Hospitalization

Current action plans may not reflect factors that influence patients’ decisions to seek care during an exacerbation, thereby delaying therapeutic interventions and increasing risks for hospitalization, according to the first abstract.¹

Patients with COPD who experience symptom changes often feel uncertain about when to seek additional care. Prespecified action plans advise them to seek care based on a set of symptoms or functional thresholds. However, these same action plans have not reliably reduced hospitalizations.

The investigators conducted a review of electronic health records from 3 hospitals in the University of Pennsylvania Health System. Patients with a suspected primary diagnosis of an exacerbation of chronic lung disease who were admitted to the hospitals were identified and interviewed along with their primary support person, admitting clinician, and primary outpatient clinician.

Sixty-nine interviews were conducted for 23 hospitalized patients, of whom 16 (70%) were women, 14 (61%) were Black, and 6 (26%) had private insurance. The mean age of the patients was 66 years.

The results of the interviews showed that most patients based their choice to seek care on several decisions. For example, decisions about whether and when to seek care were often influenced by feelings of uncertainty about how long and in what capacity symptoms would persist and whether they felt they could manage them themselves.

Additionally, individual tolerance levels for escalating symptoms and aversions to hospital-based care were identified as decision-making influences. Patients also experienced social deterrents to leaving home and bureaucratic barriers to seeking care.

The investigators said that population health management strategies aimed at reducing the risk of hospitalization should take patient decision frameworks into consideration.

Support for Readmission Reduction Program Implementation

Another abstract² demonstrated that a COPD Chronic Care Management Collaborative was effective at helping hospitals implement interventions to reduce the risk of readmission for patients with COPD.

Since Medicare’s Hospital Readmission Reduction Program for COPD was introduced, hospitals in the United States have been increasingly interested in identifying and implementing interventions to address 30-day readmissions and improve care for hospitalized patients. However, publications containing effective strategies are scarce and many hospitals require coaching and education regarding what interventions to implement and how to implement them.

In 2020, Vizient released a list of 16 Performance Improvement Collaboratives, one of which was the COPD Chronic Care Management Collaborative, a multimonth plan involving bimonthly virtual meetings that included education from subject matter experts and peer-to-peer networking over 2 parts. During meetings, enrollees deliberated about best practices, received coaching, and provided updates on project progress.

The investigators examined 47 enrolled sites accounting for 33 completions of both parts of the COPD Collaborative program. The sites spanned the United States, with 8 being located in the Southeast, 4 in the Southwest, 21 in the Midwest, 12 in the Northeast, and 2 in the Northwest.

The median/mean reach across the 20 hospitals that reported process measure data was 41%. High performers, classified as the top 25% of sites, completed both parts of the program and attended an average of 94% of monthly calls. In contrast, low performers, identified as the bottom 25% of sites, attended an average of 50% of monthly calls.

Among the sites, 83% saw improvements in rate of COPD-related emergency department (ED) revisits and/or hospital readmissions. On average, ED revisits related to COPD declined 29%, dropping from 12.7% to 9.0% to all ED revisits.

The total rate of COPD-related 30-day inpatient readmissions improved, amounting to an average 22% reduction, falling from 20.1% to 15.6% of all 30-day inpatient readmissions.

Five organizations achieved reductions for both ED revisits and hospital readmissions, while 7 achieved reductions in only 1 outcome metric.

References

1. Silvestri JA, Mullen IS, Lapite F, et al. A Qualitative Investigation of the Dynamics Underlying Decisions to Seek Care Leading Up to Hospitalizations Among People Living with Chronic Lung Disease. Presented at: ATS 2021 International Conference; May 14-19, 2021. Abstract A1572.
2. Press VG, Randall K, Hanser A. A COPD Chronic Care Management Collaborative to Support and Improve US Hospitals’ Efforts to Implement COPD Readmission Reduction Programs. Presented at: ATS 2021 International Conference; May 14-19, 2021. Abstract A1688.