Outcome of a Transitional Care Clinic to Reduce COPD Readmissions in a High-Risk Inner City Population

Abstract

SESSION TITLE: COPD 1 SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, November 1, 2017 at 01:30 PM - 02:30 PM PURPOSE: In the US, the healthcare expenditure on Chronic Obstructive Pulmonary Disease (COPD) treatment is projected to increase to $49 billion dollars by 2020. The cost for COPD readmissions is reported to be higher than initial COPD admissions. Previous reports by the Agency for Healthcare Research and Quality (AHRQ) have evidenced higher readmission rates in black and low socioeconomic status populations. According to community health profiles reports, population in central Brooklyn consist of 80% self-reported black ethnicity, with 31% living below poverty level. Managing patients with chronic medical conditions in this area is challenging because many of them do not fully understand the complexity of their illness and the importance of medication compliance. Our institution, located in central Brooklyn, established transitional care clinic (TCC) in May 2015, with aims to aid patients with chronic medical conditions by providing early post-discharge follow up regardless of patient's financial or insurance status. METHODS: A retrospective review of electronic medical records was conducted for patients who were scheduled for TCC with a diagnosis of COPD, from May 2015 to October 2016. Our TCC model includes, follow-up appointment within 7 days post-discharge and reminders via phone calls a day before TCC appointment. 30-day readmission rate was calculated and compared between patients who followed up at their TCC and who did not by Chi-squared and Fisher′s exact test. Also, readmission rates were compared for patients who followed at TCC vs. pulmonary clinic or primary care follow up, as well as for those who had pulmonary service consult as inpatient vs. those who did not. RESULTS: Total of 88 admissions for COPD were identified in the study period. Majority of patients were black (86%) with a mean age of 64 years and median length of stay of 5.8 days. Out of 67 patients who did not follow up at their TCC, 24 were readmitted (35.82%) and 6 (8.96%) visited the ED within 30 days of discharge. Of 21 patients who followed up at their TCC, 7 were readmitted (33.33%) and 1 (4.76%) visited the ED within 30 days of discharge. 40% of patients who did not show up to neither TCC nor pulmonary clinic were readmitted, compared to 22.58% who showed up to either TCC or pulmonary and 0% who followed up with both. CONCLUSIONS: Our transitional care clinic model demonstrated success with 2.49% decrease in 30-day all-cause COPD readmission and 4.2% decrease in ED visits in patients who were followed up at these clinics. Rate of readmission was significantly lower on patients who were followed at pulmonary clinic, compared to those who were followed by only TCC. When followed by both clinics no readmissions or ED visits were reported. Having pulmonary as a consulting service while inpatient showed significant reduction in the rate of readmission. In our population, successful follow up with either pulmonary or TCC was able to decrease its readmission rate to 22.58% similar to Medicare’s 22.6%. CLINICAL IMPLICATIONS: Future studies can be directed towards improving the integration of pulmonary services into the care of COPD patients and interventions focused in increasing compliance with clinic appointments (i.e.: more frequent reminders using emails, text messages, etc.). DISCLOSURE: The following authors have nothing to disclose: Felix Reyes, Justin Lee, Mafuzur Rahman, Miguel Ramirez No Product/Research Disclosure Information