Team-based approach leads to a change of nearly 50 percent
An interprofessional, multicare setting program led to readmissions being cut nearly in half over 30 days in all-cause chronic obstructive pulmonary disease.
The findings, presented at the Society of Hospital Medicine Annual Meeting, were presented by a team led by Tina Shah, MD, MPH, of the University of Chicago. Dr. Shah and colleagues developed the program to reduce all-cause 30-day readmission for patients admitted with acute exacerbation of COPD, a leading cause of readmissions.
Researchers assessed prespecified discharge coding guidelines within the Medicare Hospital Readmissions Reductions Program to define acute exacerbation of COPD, then used chart review and patient follow-up data to determine health care utilization at the hospital within 30 days.
The quality improvement model utilized for an 18-month period (from February 2014 to August 2015) consisted of:
- nurse-led inpatient pulmonary consultation;
- one-week follow-up at an outpatient clinic;
- self-management education (COPD action plan);
- pharmacy-led medication reconciliation;
- inhaler technique instruction;
- a 24-hour patient phone line; and
- a postdischarge call after 48 hours.
Out of almost 600 COPD-related admissions, only 91 of them (15.3 percent) within 30 days. The three-month readmission rate reduced from 26 percent to 11 percent, with no significant increase in ER usage.