title: Association of Psychological Disorders With 30-Day Readmission Rates in Patients With COPD.
abstract: BACKGROUND
  There is a growing understanding of the prevalence and impact of psychological disorders on COPD. However, the role of these disorders in early readmission is unclear.
  
  
  METHODS
  We analyzed data from 5% fee-for-service Medicare beneficiaries diagnosed with COPD (International Classification of Diseases, Ninth Revision code, 491.xx, 492.xx, 493.xx, and 496.xx) between 2001 and 2011 who were hospitalized with a primary discharge diagnosis of COPD or a primary discharge diagnosis of respiratory failure (518.xx and 799.1) with secondary diagnosis of COPD. We hypothesized that such psychological disorders as depression, anxiety, psychosis, alcohol abuse, and drug abuse are independently associated with an increased risk of 30-day readmission in patients hospitalized for COPD.
  
  
  RESULTS
  Between 2001 and 2011, 135,498 hospitalizations occurred for COPD in 80,088 fee-for-service Medicare beneficiaries. Of these, 30,218 (22.30%) patients had one or more psychological disorders. In multivariate analyses, odds of 30-day readmission were higher in patients with COPD who had depression (OR, 1.34; 95% CI, 1.29-1.39), anxiety (OR, 1.43; 95% CI, 1.37-1.50), psychosis (OR, 1.18; 95% CI, 1.10-1.27), alcohol abuse (OR, 1.30; 95% CI, 1.15-1.47), and drug abuse (OR, 1.29; 95% CI, 1.11-1.50) compared with those who did not have these disorders. These psychological disorders increased amount of variation in 30-day readmission attributed to patient characteristics by 37%.
  
  
  CONCLUSIONS
  Psychological disorders like depression, anxiety, psychosis, alcohol abuse, and drug abuse are independently associated with higher all-cause 30-day readmission rates for Medicare beneficiaries with COPD.
authors.affiliation: Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX. Electronic address: gpsingh@utmb.edu.
authors.forename: Gurinder
authors.initials: G
authors.lastname: Singh
authors.affiliation: Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX.
authors.forename: Wei
authors.initials: W
authors.lastname: Zhang
authors.affiliation: Office of Biostatistics, University of Texas Medical Branch, Galveston, TX; Sealy Center of Aging, University of Texas Medical Branch, Galveston, TX.
authors.forename: Yong-Fang
authors.initials: YF
authors.lastname: Kuo
authors.affiliation: Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX; Sealy Center of Aging, University of Texas Medical Branch, Galveston, TX.
authors.forename: Gulshan
authors.initials: G
authors.lastname: Sharma
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000437:Alcoholism / Q000453:epidemiology / Q000523:psychology; D001007:Anxiety / Q000453:epidemiology / Q000523:psychology; D001008:Anxiety Disorders / Q000453:epidemiology / Q000523:psychology; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology / Q000523:psychology; D003866:Depressive Disorder / Q000453:epidemiology / Q000523:psychology; D018450:Disease Progression; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D006278:Medicare; D001523:Mental Disorders / Q000453:epidemiology* / Q000523:psychology; D015999:Multivariate Analysis; D016017:Odds Ratio; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011618:Psychotic Disorders / Q000453:epidemiology / Q000523:psychology; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology* / Q000523:psychology; D012189:Retrospective Studies; D012307:Risk Factors; D012923:Social Class; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000523:psychology; D014481:United States / Q000453:epidemiology
keywords: COPD; anxiety; depression; medicare; readmission