Hospital Readmission Due to Chronic Obstructive Pulmonary Disease: A Longitudinal Study.

Chidiamara Maria Njoku,Barbara Caecilia Wimmer,Leigh Kinsman,Gregory Mark Peterson,Bonnie Jayne Bereznicki

doi:10.34172/ijhpm.2022.5770

Abstract

This study aimed to investigate the prevalence of hospital readmission for chronic obstructive pulmonary disease (COPD) at 30, 90 and 365 days, and to determine demographic and socioeconomic risk factors for 30-day and 90-day readmission and time to COPD-related readmission within 365 days in Tasmania. Patients ≥40 years admitted for COPD between 2011 and 2015 were identified using administrative data from all major public hospitals in Tasmania, Australia. Factors associated with readmission and time to readmission were identified using logistic and Cox regression, respectively. The rates of COPD-related readmission were 6.7% within 30 days, 12.2% within 90 days and 23.7% within 365 days. Being male (odds ratio [OR]: 1.49, CI: 1.06-2.09), Indigenous (OR: 2.47, CI: 1.31-4.66) and living in the lower socioeconomic North-West region of Tasmania (OR: 1.80, CI: 1.20-2.69) were risk factors for 30-day readmission. Increased COPD-related (OR: 1.48, CI: 1.22-1.80; OR: 1.52, CI: 1.29-1.78) and non-COPD-related (OR: 1.12, CI: 1.03- 1.23; OR: 1.11, CI: 1.03-1.21) emergency department (ED) visits in the preceding six months were risk factors for both 30-day and 90-day readmissions. Being Indigenous (hazard ratio [HR]: 1.61, CI: 1.10-2.37) and previous COPD-related ED visits (HR: 1.30, CI: 1.21-1.39) decreased, while a higher Charlson Comorbidity Index (CCI) (OR: 0.91, CI: 0.83- 0.99) increased the time to readmission within 365 days. Being male, Indigenous, living in the North-West region and previous ED visits were associated with increased risk of COPD readmission in Tasmania. Interventions to improve access to primary healthcare for these groups may reduce COPD-related readmissions.

Highlights

Chronic obstructive pulmonary disease (COPD) places a substantial burden on patients and healthcare systems around the globe
Our findings indicated that male patients, Indigenous people, and those living in the lower socioeconomic region were more likely to be readmitted for chronic obstructive pulmonary disease (COPD) in Tasmania
Being male, Indigenous (OR: 2.47, 95% confidence interval (CI): 1.31–4.66), living in the North-West region (OR: 1.80, 95% CI: 1.20–2.69), and increased COPD-related (OR: 1.48, 95% CI: 1.22–1.80) and non-COPD-related (OR: 1.12, 95% CI: 1.03–1.23) emergency department (ED) visits in the previous six months were significant risk factors for 30-day readmission

Summary

Introduction

Chronic obstructive pulmonary disease (COPD) places a substantial burden on patients and healthcare systems around the globe. Leading cause of disability-adjusted life years lost across the world in 2013.3 Based on the Global Initiative for Obstructive Lung Disease criteria, 14.5% of Australians aged 40 years and over had COPD in 2010.4 COPD was the most common chronic condition associated with potentially preventable. There were variations in the reported factors associated with risk of readmission, which may reflect differences in the local context, such as the availability of community-based services to prevent and care for exacerbation of COPD. It was recommended that risk factors for COPD-related readmissions should be considered in the light of locality due to variations in healthcare systems around the world.[11]

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Conclusion