Factors associated with inpatient readmission among managed care enrollees with COPD

Abstract

OBJECTIVE: To assess factors associated with inpatient readmission among a US managed care population with chronic obstructive pulmonary disease (COPD). BACKGROUND: COPD is often accompanied by intermittent acute exacerbations, which may result in hospitalizations. These exacerbations are often associated with an increased frequency of subsequent exacerbations, which may lead to inpatient readmissions. METHODS: We assessed US managed care claims data for enrollees >/= 40 years old with an inpatient admission with a primary diagnosis of COPD (ICD-9-CM codes 491.xx, 492.xx or 496.xx) between 1 January 2010 and 31 December 2013 (discharge date of first observed inpatient admission defined the 'index date'). Patients were required to be continuously enrolled for >/= 12 months before the index date. Two non-mutually exclusive cohorts were analyzed: (1) patients with >/= 30 days of post-index date continuous enrollment (to evaluate 30-day readmission) and (2) patients with >/= 90 days of post-index date continuous enrollment (to evaluate 90-day readmission). Logistic regression evaluated the association between patient characteristics and risk of 30- and 90-day COPD-related and all-cause readmission. RESULTS: After applying selection criteria, 140,981 patients had >/= 30 days of enrollment post-index date, and 123,545 patients had >/= 90 days of enrollment post-index date. Within 30 days, nearly 20% of patients had an all-cause readmission and 7% had a COPD-related readmission. Within 90 days, 28% had an all-cause readmission and 12% had a COPD-related readmission. Logistic regression indicated that longer length of stay, older age, greater comorbidity burden, specific comorbidities and COPD complexity were associated with significantly greater odds of COPD-related 30- and 90-day readmission. Results for all-cause readmission were generally similar. CONCLUSIONS: Many of the factors associated with inpatient readmission documented here can be ascertained at discharge and may be used to inform discharge plans, with the end goal of improving patient outcomes, including reducing the risk of readmission