Does Readmission to a Different Hospital Impact Costs and Outcomes for COPD?

Among patients with chronic obstructive pulmonary disease (COPD) exacerbations, readmission to a different hospital is associated with higher mortality, increased hospital length of stay (LOS), and increased cost of hospitalization, according to a study being presented at the CHEST Annual Meeting 2019.

Researchers collected information on readmission for patients with COPD-related hospitalization from the Nationwide Readmission Database for the year 2014. They categorized 30-day readmissions as return to same versus different hospital. A total of 949,830 index COPD admissions were identified, 255,338 (26.8%) of which were readmitted within 30 days. In this cohort, 21.9% of readmissions were to a different hospital, while 78.1% were to the same hospital.

Predictors of readmission to a different hospital included younger age (odds ratio [OR], 0.986; 95% confidence interval [CI], 0.984-0.988; P<0.001) and male sex (OR, 1.16; 95% CI, 1.11-1.21; P<0.001). A predictor of readmission to the same hospital was higher median household income (OR, 0.89; 95% CI, 0.81-0.99; P<0.03).

Elective readmissions accounted for 5.1% of total readmissions and were more common among patients readmitting to a different hospital (OR, 1.55; 95% CI, 1.41-1.71; P<0.001). Median time to readmission was 13.5 days, and comorbidities were similar in both cohorts.

Readmission to a different hospital resulted in increased in-hospital mortality (7.6% vs. 6.7%; P<0.001; OR, 1.13; 95% CI, 1.06-1.21; P<0.001), increased hospital LOS (6.99 vs. 6.08; P<0.001; 95% CI, 0.84-0.97), and increased cost of hospitalization ($60,569 vs. $47,335; P<0.001; 95% CI, 12,375-14,093).

“Continuity of care in COPD can allow physicians to offer patients a [timelier] diagnosis and appropriate management,” the authors concluded. “Allocating resources to minimize different hospital COPD readmissions can result in improved outcomes and limit its high cost on the healthcare system.”

Reference

1. Shammaa Y, Mansour W, Karam B, et al. COPD readmission outcomes: same-hospital vs different hospital. Presented at the CHEST Annual Meeting 2019. October 19-23, 2019; New Orleans, Louisiana.