title: A retrospective analysis to identify predictors of COPD-related rehospitalization.
abstract: BACKGROUND
  Chronic obstructive pulmonary disease (COPD) is often associated with recurrent hospitalizations. This study aimed to identify factors related to COPD rehospitalization.
  
  
  METHODS
  A national US claims database was used to identify patients, aged ≥40 years, hospitalized for COPD. Their first COPD-related hospital admission date in 2009 was set as the index date, with post-discharge COPD-related rehospitalization assessed for 180 days post-index date. Data were analyzed for: 1) all eligible patients in whom early COPD-related rehospitalization was evaluated (1-30 days post discharge; all-patient cohort) and 2) a patient subset not rehospitalized early in whom late COPD-related rehospitalization was evaluated (>30 days post discharge to 180 days post-index date; late cohort). Logistic regressions controlling for age and sex assessed potential COPD-related rehospitalization predictors. Variables from the 360-day pre-index period and index hospitalization were evaluated for each cohort, and 30-day post-discharge variables evaluated for the late cohort.
  
  
  RESULTS
  Of 3612 patients with an index hospitalization, 4.8 % (174) had an early COPD-related rehospitalization, and of the remaining 3438 patients, 13.7 % (471) had a late COPD-related rehospitalization. Several pre-index variables were predictive of early COPD-related rehospitalization including: pneumonia; comorbidities; COPD-related drug therapies; and prior hospitalizations. In patients not rehospitalized early, the strongest predictor of late COPD-related rehospitalization was pre-index COPD-related hospitalization (OR = 3.64 [P < 0.001]). The strongest index hospitalization factors predictive of late COPD-related rehospitalization were use of steroids (any route: OR = 1.62 [P = 0.007]) and nebulizers (OR = 1.65 [P = 0.007]); neither predicted early COPD-related rehospitalization. Generally, factors predicting COPD-related rehospitalization were similar in both cohorts.
  
  
  CONCLUSIONS
  Several pre-index variables were associated with COPD-related rehospitalization. A strong predictor of COPD-related rehospitalization was prior hospitalization during the pre-index period, particularly with a primary COPD diagnosis, whilst other predictive factors related to increased COPD severity; these may be useful indicators for COPD-related rehospitalization risk assessment. Some factors, e.g., recurrent pneumonia and exacerbations, may be modifiable.
authors.affiliation: Lovelace Clinic Foundation, 2309 Renard Place SE, Suite 103, Albuquerque, NM, 87106, USA. MRoberts@lcfresearch.org.
authors.forename: Melissa H
authors.initials: MH
authors.lastname: Roberts
authors.affiliation: Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, CT, USA.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Clerisme-Beaty
authors.affiliation: CK Consulting, St. Helena Island, SC, USA.
authors.forename: Chris M
authors.initials: CM
authors.lastname: Kozma
authors.affiliation: Vigilytics LLC, Victor, NY, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Paris
authors.affiliation: TLS Statistics, West Columbia, SC, USA.
authors.forename: Terra
authors.initials: T
authors.lastname: Slaton
authors.affiliation: Lovelace Clinic Foundation, 2309 Renard Place SE, Suite 103, Albuquerque, NM, 87106, USA.
authors.forename: Douglas W
authors.initials: DW
authors.lastname: Mapel
mesh_terms: D000367:Age Factors; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000639:trends*; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D014481:United States / Q000453:epidemiology
keywords: Chronic obstructive pulmonary disease (COPD); Comorbidity; Exacerbations; Readmission predictors; Rehospitalization; Utilization