SESSION TITLE: COPD: Lessons for the Real-World Management of Disease SESSION TYPE: Original Investigation Slide PRESENTED ON: Tuesday, October 31, 2017 at 02:45 PM - 04:15 PM PURPOSE: Chronic obstructive pulmonary disease (COPD) has become a major focus as Medicare’s “Readmission reduction program” increased strict readmission guidelines in the last decade. This resulted in burdensome cost cuts to health systems. However, little guidance has been provided on how to prevent readmissions. Many have created bundles aimed at enhancing the care of patients with COPD on admission by utilizing evidence based practice. In addition to providing high quality care it is also important to focus on methods for readmission prevention. In this study we sought to determine easily identifiable patient characteristics in those readmitted within 90 days of an exacerbation of COPD. METHODS: A retrospective medical record review was conducted at 2 large tertiary teaching hospitals which identified patients that were admitted with a COPD exacerbation from January 1st, 2010 to June 30th, 2016. Descriptive statistics of the admission and patient characteristics are provided for continuous and categorical variables in the study. Continuous variables are described using the mean and standard deviation for normally distributed variables and the median and interquartile range (25th-75th percentiles) for skewed distributions. Categorical variables are described using frequency counts and percentages. A comparison of admissions that had a COPD readmission within 90 days were made to those that did not using two-sample t-tests, Wilcoxon rank-sum tests, and Pearson’s chi-square or Fisher’s exact tests, as appropriate. Logistic regression models were used to obtain unadjusted odds ratios and their 95% confidence intervals. RESULTS: There were 4,709 patients that met the study inclusion criteria. Of these, 751 (15.9%) were readmitted within 90 days. Many aspects were shown to have a significant association with increased 90-day readmission including medication factors: opioid use prior to admission (OR = 1.82, 95% CI [1.52-2.18]), systemic steroid use on discharge (OR = 2.24, 95% CI [1.86-2.70]); and medical history factors: previous or current lung cancer (OR = 1.59, 95% CI [1.20-2.12]), obstructive sleep apnea (OR = 1.70, 95% CI [1.42-2.04]), asthma (OR = 3.08, 95% CI [2.47-3.85]), and ILD (OR = 2.02, 95% CI [1.66-2.45]). Some features that were shown to have a significant decrease in 90 readmission rates included new antiarrhythmic medication at discharge (OR = 0.42, 95% CI [0.22-0.78]), discharge bicarbonate level between 25-30 mmol/L (OR = 0.53, 95% CI [0.43-0.64]), and patients 65 years or older with Prevnar immunization (OR = 0.54, 95% CI [0.31-0.93]). Interestingly, 648 out of 1,449 (44.7%) patients with elevated procalcitonin levels were less likely to be readmitted within 90 days (OR = 0.49, 95% CI [0.36-0.65]). CONCLUSIONS: We have demonstrated several characteristics of COPD readmissions. While numerous could be expected, others were more paradoxical to what has been previously reported. CLINICAL IMPLICATIONS: Emphasis should be placed on methods to decrease readmission rates, thereby reducing morbidity, mortality, and onerous financial setbacks. Recognizing targetable similarities will lead to more weighted aggregation of health care resources attentive upon these “higher risk” patients. DISCLOSURE: The following authors have nothing to disclose: Kenneth Snell, Christopher Breen, Molly Herring, Kevin Maguire No Product/Research Disclosure Information