Preventing COPD readmissions under the Hospital Readmissions Reduction Program: How far have we come?

The Hospital Readmissions Reduction Program (HRRP) was developed and implemented by the Centers for Medicare and Medicaid Services to curb the rate of 30-day hospital readmissions for certain common and high impact conditions. In October 2014, chronic obstructive pulmonary disease (COPD) became a target condition for which hospitals were penalized for excess readmissions. The appropriateness, utility and potential unintended consequences of the metric have been a topic of debate since it was first enacted. Nevertheless, there is evidence that hospital policies broadly implemented in response to the HRRP may have been responsible for reducing the rate of readmissions after COPD hospitalizations even before it was added as a target condition. Since its addition to the HRRP, several predictive models have been developed to predict COPD survival and readmissions with the intention of identifying modifiable risk factors. A number of interventions have also been studied with mixed results. Bundled care interventions using the electronic health record and patient education interventions for inhaler education have been shown to reduce readmissions, while pulmonary rehabilitation, follow up visits and self-management programs have not been consistently shown to do the same. Through this program, COPD has become recognized as a public health priority. However, five years after COPD became a target condition for HRRP, there continues to be no single intervention that reliably prevents readmissions in this patient population. Further research is needed to understand the long-term effects of the policy, the role of competing risks in measuring quality, the optimal post-discharge care for patients with COPD and the integrated use of predictive modeling and advanced technologies to prevent COPD readmissions.

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