Assessment of COPD Overdiagnosis as an Important Factor in COPD Readmission

Abstract

Introduction: The Hospital Readmission Reduction Program (HRRP) was established in 2012 to improve health care by linking payment to the quality of hospital care. Readmission is considered a hospital care quality measure. Under the program, hospitals are penalized for Chronic Obstructive Pulmonary Disease (COPD) readmission, which incentivizes improved care to avoid financial penalties. The effect of COPD overdiagnosis on COPD readmission has not been studied. Objective: The study aims to assess the effect of COPD overdiagnosis in outpatient and inpatient settings on hospital COPD readmissions. Methods: We conducted a retrospective study and examined outpatient and inpatient settings for COPD overdiagnosis. In the outpatient setting, we collected all COPD referrals to our clinic and reviewed charts to determine if those patients had COPD or an alternate diagnosis after our workup. We also studied 3-year inpatient data from January 2015 to March 2018 on hospital readmissions and extracted COPD readmissions. For patients seen by a pulmonary provider in our clinic, we studied patients’ pulmonary function test/ spirometry results and charts and determined if they had a true COPD diagnosis or an overdiagnosis. We also assessed the effect of COPD overdiagnosis on inflation of COPD readmission numbers. Results: Of patients referred to our clinic, 46% did not have COPD on our workup. Among inpatients, our results revealed that preventing COPD overdiagnosis could have reduced admissions attributable to COPD by 22.6%. Conclusion: Correct diagnosis using the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria is an inexpensive way for hospitals to avoid readmission penalties.