A personal touch; Case management-led attempted reduction of COPD readmissions.
Fernandez-Castillo J, Small B, Hurick-Miles L, and Swiderek J. A personal touch; Case management-led attempted reduction of COPD readmissions. Chest 2015; 148(4).
Chronic Obstructive Pulmonary Disease (COPD) is one of the leading causes of morbidity and mortality in the United States. The management of patients with COPD and occurrences of acute COPD exacerbations are a significant financial burden on the health care system. A variety of interventions have been used to decrease COPD readmissions; including disease education, inhaler teaching, close post-discharge follow-up, and smoking cessation. We sought to determine whether a transitional case manager intervention would reduce readmissions for COPD exacerbations. Methods: A retrospective chart review was conducted identifying patients admitted to 800bed urban teaching hospital with a COPD exacerbation, from January 2013 to May 2014, pre-and post-implementation of a transitional case manager. 100 patients were included from both groups, excluding those with no clear evidence of COPD. The post-intervention group had a dedicated case manager who conducted disease education, inhaler teaching, provided smoking cessation resources, discharge planning and follow-up. The primary outcome was difference in 30-day readmission between the pre-and post-intervention groups. Results: Of the 200 patients, 15 of 100 (15%) in the pre-intervention group and 18 of 100 (18%) in the post-intervention group were readmitted within 30 days (p=0.56). We did show that a variety of patient-specific factors are significantly associated (p <0.05) with 30-day readmission including oxygen use on admission and discharge, ICU admission during hospital stay, prior admission for COPD within the past year, FEV1 and FEV1/FVC, in addition to co-morbidities including cerebrovascular disease and mood or anxiety disorder. Conclusions: A case manager implementation with multiple interventions failed to demonstrate a significant difference in 30-day readmissions in patients admitted for COPD exacerbation. Confounding factors include; the nature of this study being retrospective, and differences between pre and post intervention groups including the Charlson score. Clinical Implications: Multiple attempts aimed at prevention of 30-day readmissions in the COPD patient population have been pursued, most being fruitless. Further investigations/interventions are needed to prevent readmission through outpatient outreach, Telehealth and Home Care. In addition, it remains to be determined which patients may be candidates for outpatient therapy or observation hospital stay rather than full admission.