A DISCHARGE CARE BUNDLE REDUCES READMISSIONS IN PATIENTS WITH ACUTE EXACERBATION OF COPD

Abstract

SESSION TITLE: Late Breaking Abstracts SESSION TYPE: Original Investigations PRESENTED ON: 10/08/2018 04:30 PM - 05:30 PM PURPOSE: Chronic obstructive pulmonary disease (COPD) remains the third most common cause of readmission among Medicare beneficiaries, occurring in 60% of patients within one year of hospital discharge and in 30% within 3 months of discharge. Decreasing readmissions in this patient population improves patient health and decreases healthcare utilization of resources. The purpose of this study was to determine if a COPD care bundle delivered by a multidisciplinary health care team will reduce hospital readmission rates for acute exacerbations of COPD (AECOPD). METHODS: A prospective cohort design study with pre and post intervention arms was conducted. From April to September of 2016, patients admitted with AECOPD at Morristown Medical Center (MMC) were enrolled in the pre-intervention group. Subsequently an evidence-based COPD care bundle was developed with three primary objectives: (1) Patient education on COPD by healthcare providers prior to discharge; (2) Completion of an individualized self-management COPD action plan to be used by patients after hospital discharge; and (3) Timely outpatient follow-up with a pulmonologist. After this COPD care bundle was implemented in April of 2017, patients admitted with AECOPD at MMC from April to September of 2017 were enrolled in the post-intervention group. Patient characteristics, hospital length of stay (LOS), discharge location, and readmission rates for both groups were collected. Statistical analysis were carried out using Pearson chi-square test or Fisher exact test for categorical variables and 2-sample t-test or Mann Whitney test for continuous variables. The primary outcome was 30-day readmission rates. Secondary outcome was hospital LOS. RESULTS: 150 patients were enrolled in the pre-intervention group and 221 patients were enrolled in the post-intervention group. The two groups were similar in clinically relevant patient characteristics. 30-day readmission rate was lower in the post-intervention group, 22.2% vs. 32.7% (p=0.024). 60-day and 90-day readmission rates were also lower in the post-intervention group, 30.3% vs. 56.0% (p< 0.001) and 35.3% vs. 62.6% (p<0.001), respectively. Hospital length of stay was similar between the two groups, 8 days vs. 7 days (p=0.322). CONCLUSIONS: Implementation of a discharge care bundle in patients admitted with AECOPD significantly and consistently reduced 30 day hospital readmission rates in our patient population without increasing hospital length of stay. This reduction in readmissions was sustained through 60 and 90 days. CLINICAL IMPLICATIONS: A multidisciplinary discharge program can be easily implemented and can improve patient outcomes in those admitted with AECOPD. Such a program should be considered in all hospitals. DISCLOSURES: No relevant relationships by Federico Cerrone, source=Web Response No relevant relationships by Stephanie Chiu, source=Web Response No relevant relationships by Joan Corasaniti, source=Web Response No relevant relationships by Krystal Fitzpatrick, source=Web Response No relevant relationships by Moira Kendra, source=Web Response No relevant relationships by Lisa Landry, source=Web Response No relevant relationships by Beverly Natale, source=Web Response No relevant relationships by Natalie Reyes, source=Web Response No relevant relationships by Chirag Shah, source=Web Response