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Hospital Readmissions for COPD

To curb this growing strain on the healthcare industry, education is needed.

Chronic obstructive pulmonary disease (COPD) exerts a major strain on the American healthcare system, mostly due to the high number of hospitalizations and emergency department visits associated with exacerbations.1 Generally, COPD is a treatable and manageable disease process for many patients in the early stages. However, the disease presents many morbidity and mortality issues that complicate management and care.

Nearly 24 million people in the United States have COPD, and it is now the third leading cause of death in this country.1 In 2015, COPD cost the healthcare system nearly $53 billion.2 This encompassed $32.4 billion in direct medical costs, $10.4 billion in indirect costs and $9.9 billion in costs associated with premature death.2 Hospital readmissions associated with COPD have become a major focal point due to their financial impact. Readmissions for COPD cost Medicare more than $15 billion annually.3 What can be done to help reduce this growing problem?

A Multifaceted Strain
Numerous costs are associated with the management and ongoing care of patients with COPD, and many people and communities are impacted by the complex care required.4 From a financial standpoint, the major costs are associated with direct care; time lost from work; family burdens; morbidities; and premature mortality.4 The highest costs associated with COPD, as mentioned previously, result from hospitalization.4 Unfortunately, the bills do not stop once the patient is discharged.

Adding to the burden are high readmission rates. In 1993, the annual cost of COPD care in the U.S. was nearly $24 billion. It is more than double that now, and was $53 billion in 2015.2,4 A 2008 statistical study of readmissions for COPD in 15 states found that the cost of readmission for patients with COPD-associated illnesses was 18% to 50% higher than the initial hospitalization only 30 days earlier.5 The initial visit cost was around $5,000 for treatment, but the readmission cost often approached $10,000.5 These data show clearly that this disease, if not managed more effectively, will further eat away at healthcare dollars, hospital resources, patient outcomes, and familial structures.

In terms of what is acceptable as quality care for healthcare facilities, Medicare is often in the driver's seat. Reimbursements are tied directly to care quality; and to measure this, Medicare closely examines readmission rates because they may be an indicator of subpar inpatient or discharge care.6 Because readmission rates are a major contributor to rising healthcare costs, Medicare now imposes penalties for readmissions associated with the major diseases at the root of this problem-including COPD.6 The idea behind this is that if hospitals directly feel the financial impact of readmission, they will be more inclined to develop and execute more effective care plans to reduce the number of repeat hospitalizations. Unfortunately, once discharged, it is difficult for a hospital to provide continued care and monitor at-risk patients. The responsibilities then lie in the hands of primary care providers and specialists in the community . and in the hands of the patients.

SEE ALSO: Adult-Onset Allergies

How to Bridge the Gap
During an inpatient stay, many resources aim to help patients build a strong foundation for an effective plan of care. Social workers, specialists, support groups, and various therapy groups try to provide patients with techniques and education to help them better manage their disease. The hope is that these interventions will prevent or at least limit the number of future exacerbations. One of the biggest contributors to COPD exacerbations is exposure to cigarette smoke.6

One of the most effective means of reducing COPD exacerbations is thorough patient education about risk reduction. But this has proven to be a difficult task.6 It also has been difficult to adequately educate primary care providers about how to reduce COPD risk.6 Some reasons for this are that primary care providers are often unwilling to perform testing, are resistant to taking part in certain pulmonary programs, or are not managing their COPD patients properly.6

Other areas of concern associated with ongoing post-hospitalization care are an appropriately timed follow-up visit with a primary care provider or specialist (within 2 weeks of discharge); barriers to ongoing care; smoking cessation; vaccination; and appropriate prescribing.1, 6 Patient barriers include financial status; access to healthcare (i.e., transportation); willingness to adhere to recommended treatment and prevention; educational level; physical impairments; and lack of familial or social support.6

Today, the healthcare system is making strides in providing services to as many people as possible. Using more nurse practitioners and physician assistants, telemedicine and expanded services is allowing healthcare to reach people who previously had not had an easy method to obtain medical treatment. Designing educational materials in various forms and at lower reading levels has made them easier to understand by patients.

Education Plus Treatment
Education combined with adherence to current recommended pharmacological approaches appears to be the most effective way to limit COPD exacerbations.1 But as stated, educating patients and providers can be difficult. Some research suggests that COPD patients are most effectively treated when pulmonary specialists are involved.2 However, the same study shows that many patients seek care from primary care providers or the local emergency department far more often.2 Thus, it may be easier said than done to readily involve pulmonary specialists in each COPD case.

One thing is for sure: It is time to start implementing a plan to reverse the upward costs of this disease. This difficult challenge must be accepted and overcome in order to corral the enormous burden COPD presents to the healthcare industry. With a growing and aging population, healthcare in the United States must approach this and every disease process in a teamwork fashion to be successful. 

Justin Jeffries is a nurse practitioner for Senior LIFE of Pennsylvania, based in Greensburg, Pa.

References

1. Qureshi H, et al. Chronic obstructive pulmonary disease exacerbations: latest evidence and clinical implications. Ther Adv Chronic Dis. 2014;5(5):212-217.

2. Kim M, et al. Explaining the link between access-to-care factors and health care resource utilization among individuals with COPD. Int J COPD. 2016;(11):357-367.

3. Sullivan SD, et al. The economic burden of COPD. Chest. 2000;117(2 Suppl):5S-9S.

4. Fingar K, Washington R. Trends in Hospital Readmissions for Four High-Volume Conditions, 2009-2013. Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. 2015;1-17.

5. Elixhauser A, et al. Readmissions for chronic obstructive pulmonary disease, 2008. Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. 2008;1-9.

6. Messenger R. Reducing readmissions in the COPD population. RT Magazine. http://www.rtmagazine.com/2013/03/reducing-readmissions-in-the-copd-population-2/

 

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