QUALITY IMPROVEMENT PROJECT TO REDUCE COPD READMISSION RATE IN MEDICARE PATIENTS USING A MULTIDISCIPLINARY PROTOCOL-BASED CARE PLAN

Abstract

SESSION TITLE: Electronic Top Posters SESSION TYPE: Original Inv Poster Discussion PRESENTED ON: 10/08/2018 01:15 pm - 02:15 pm PURPOSE: A quality improvement (QI) project was initiated at the Houston Methodist Hospital (HMH) to reduce the readmission rate for acute exacerbation of COPD (AECOPD). Our goal was to reduce the 30-day all cause readmission rate using a multidisciplinary and focused care plan for high-risk patients. METHODS: Beginning in 2016, all patients admitted to HMH with the primary diagnosis of AECOPD had a standardized care plan based on the Global Initiative for Chronic Obstructive Lung Disease guideline implemented prior to hospital discharge. Patients with a concurrent diagnosis of congestive heart failure exacerbation, active lung cancer or history of a lung transplant were excluded. The project involved physicians, nurses, case managers, social workers, respiratory therapists, project coordinators and the Houston Methodist Research Institute. Moreover, in 2017, a multidisciplinary group met weekly to identify high risk patients (having >50% likelihood of readmission based on internally developed software, ReAdmit app) and offered focused care. The interventions included diagnostics, medical treatments, nutrition, teaching, psychosocial assessment, discharge planning and outpatient follow up plans. The utilization of the care plan was at the discretion of the attending physician, and every hospitalist in our hospital was educated and encouraged to follow the plan. The intervention was applied to all patients; this study we focused on Medicare patients. We obtained baseline readmission data (2011–2015) and compared with the intervention period (2016 and 2017). The data was analyzed using Student’s t-test. RESULTS: A total of 994 Medicare patients were admitted for AECOPD from 2011 to 2015 prior to the intervention; 238 patients were readmitted within 30-days after discharge (23.9%, CI: 21.3%-26.5%) (Table 1). The readmission rate was 25.1% (55 out of 219, p-value = 0.270) in 2016, and 17.7% (50 out of 283, p-value = 0.00271) in 2017 (Figure 1). In 2017, there was an absolute risk reduction of 6.2% and 25.9% relative risk reduction of being readmitted. The number-needed-to-treat to avoid readmission was 17. CONCLUSIONS: A multidisciplinary care plan approach for Medicare patients with AECOPD resulted in a statistically significant reduction in the rate of readmission. Due to the nature of a QI project, the care plan was not equally applied to patients, as it was the attending physicians’ discretion to utilize each aspect of the formulated care plan. Nevertheless, this study strongly suggests that a standardized multidisciplinary care plan decreases 30-day readmission for patients admitted for AECOPD. CLINICAL IMPLICATIONS: Based on this model, we plan to modify an AECOPD admission order set in our electronic medical record system to make it easier for physicians to incorporate our standardized plan. We plan to analyze readmission rates for non-Medicare patients to determine if there is a similar effect. DISCLOSURES: No relevant relationships by Aida Coralic, source=Admin input Speaker/Speaker's Bureau relationship with ACTELION PHARMACEUTICALS Please note: $5001 - $20000 Added 01/22/2018 by Adaani Frost, source=Web Response, value=Honoraria ENDPOINT ADJUDICATION COMMITTEE relationship with UNITED THERAPEUTICS Please note: $1001 - $5000 Added 01/22/2018 by Adaani Frost, source=Web Response, value=Honoraria No relevant relationships by Robert Jackson, source=Web Response No relevant relationships by Jared Lee, source=Web Response No relevant relationships by Mamta Puppala, source=Web Response No relevant relationships by Lilianna RajtakMuller, source=Web Response No relevant relationships by Elena Ruocco, source=Admin input No relevant relationships by Lin Wang, source=Web Response No relevant relationships by Stephen Wong, source=Web Response