Abstract
Despite all the advances in the treatment and management of chronic obstructive pulmonary disease (COPD), COPD readmissions remain a major challenge nationwide. Increasing evidence suggests that palliative care involvement with a holistic approach towards end-of-life care can significantly improve outcomes related to the quality of life and survival for late-stage cancers and chronic progressive illnesses like COPD, chronic heart failure, and end-stage renal disease. Some studies have attempted to evaluate an association between the involvement of palliative care and readmission reduction, the effect of which remains elusive, especially with regards to COPD readmissions. This review examined the existing literature to analyze the relationship between palliative care involvement for COPD patients and its effect on COPD readmissions.
Highlights
BackgroundAccording to the World Health Organization (WHO), chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide, affecting about 65 million people [1]
Patients admitted to the hospital with a COPD exacerbation have a median survival of two years, and 50% of them will be readmitted within six months. 10-20% of COPD patients are readmitted within the 30 days of discharge from the hospital, which roughly accounts for about $325 million per year in healthcare expenditures [2]
COPD was made a part of Medicare's Hospital Readmissions Reduction Program (HRRP) to address this problem
Summary
According to the World Health Organization (WHO), chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide, affecting about 65 million people [1]. In 2011, in a single-center small sample size study, found that involving the multi-disciplinary end-of-life care team compared to single palliative consult yielded better readmission rates and cost outcomes. They did not account for the timing of palliative care intervention and the comorbid illnesses [17]. This was followed by other studies, including the nationwide inpatient sample analysis by O'Connor et al in 2015, where 4.1% (1430) of 34541 patients received inpatient palliative care consultations, and the propensity-matched scoring indicated that those with IPCs had lower 30-day readmissions (AOR: 0.66) compared to patients who did not receive it. Like COPD, heart failure is a nonmalignant extended life-limiting disease with a high symptom burden and reduced quality of life [26,27]
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