1 Department of Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences.
2 Department of Epidemiology and Environmental Health, School of Public Health and Health Professions.
Ann Am Thorac Soc. 2018 Jul;15(7):837-845. doi: 10.1513/AnnalsATS.201712-913OC.
Understanding the causes and factors related to readmission for an acute exacerbation of chronic obstructive pulmonary disease (AECOPD) within a nationwide database including all payers and ages can provide valuable input for the development of generalizable readmission reduction strategies.
To determine the rates, causes, and predictors for early (3-, 7-, and 30-d) readmission in patients hospitalized with AECOPD in the United States using the Nationwide Readmission Database after the initiation of the Hospital Readmissions Reduction Program, but before its expansion to COPD.
We conducted an analysis of the Nationwide Readmission Database from 2013 to 2014. Index admissions and readmissions for an AECOPD were defined consistent with Hospital Readmissions Reduction Program guidelines. We investigated the percentage of 30-day readmissions occurring each day after discharge and the most common readmission diagnoses at different time periods after hospitalization. The relationship between predictors (categorized as patient, clinical, and hospital factors) and early readmission were evaluated using a hierarchical two-level logistic model. To examine covariate effects on early-day readmission, predictors for 3-, 7-, and 30-day readmissions were modeled separately.
There were 202,300 30-day readmissions after 1,055,830 index AECOPD admissions, a rate of 19.2%. The highest readmission rates (4.2-5.5%) were within the first 72 hours of discharge, and 58% of readmissions were within the first 15 days. Respiratory-based diseases were the most common reasons for readmission (52.4%), and COPD was the most common diagnosis (28.4%). Readmission diagnoses were similar at different time periods after discharge. Early readmission was associated with patient (Medicaid payer status, lower household income, and higher comorbidity burden) and clinical factors (longer length of stay and discharge to a skilled nursing facility). Predictors did not vary substantially by time of readmission after discharge within the 30-day window.
Thirty-day readmissions after an AECOPD remain a major healthcare burden, and are characterized by a similar spectrum of readmission diagnoses. Predictors associated with readmission include both patient and clinical factors. Development of a COPD-specific risk stratification algorithm based on these factors may be necessary to better predict patients with AECOPD at high risk of early readmission.
在一个包括所有支付者和年龄段的全国性数据库中，了解慢性阻塞性肺疾病急性加重（AECOPD）再入院的原因和相关因素，可以为制定可推广的再入院率降低策略提供有价值的依据。
在美国，在医院再入院率降低计划实施后但尚未扩大到 COPD 之前，利用全国再入院数据库，确定 AECOPD 住院患者在早期（3、7 和 30 天）再入院的发生率、原因和预测因素。
我们对 2013 年至 2014 年的全国再入院数据库进行了分析。指数入院和 AECOPD 再入院的定义与医院再入院率降低计划的指南一致。我们调查了出院后每天发生 30 天再入院的百分比以及不同住院时间后最常见的再入院诊断。使用分层两水平逻辑模型评估预测因素（分为患者、临床和医院因素）与早期再入院的关系。为了检查早期再入院的预测因素，分别对 3 天、7 天和 30 天再入院的预测因素进行建模。
在 1055830 例 AECOPD 指数入院后，有 202300 例 30 天再入院，再入院率为 19.2%。出院后前 72 小时的再入院率最高（4.2-5.5%），58%的再入院发生在出院后 15 天内。基于呼吸系统的疾病是再入院的最常见原因（52.4%），而 COPD 是最常见的诊断（28.4%）。出院后不同时间的再入院诊断相似。早期再入院与患者（医疗补助支付者身份、较低的家庭收入和较高的合并症负担）和临床因素（较长的住院时间和出院到熟练护理机构）有关。在 30 天的时间窗口内，出院后不同时间的再入院的预测因素没有明显差异。
AECOPD 后 30 天的再入院仍是一个主要的医疗保健负担，其再入院诊断特征相似。与再入院相关的预测因素包括患者和临床因素。基于这些因素制定 COPD 特定的风险分层算法可能是必要的，以便更好地预测 AECOPD 患者早期再入院的高风险。
