title: COPD Readmissions: Addressing COPD in the Era of Value-based Health Care.
abstract: Of those patients hospitalized for an exacerbation of COPD, one in five will require rehospitalization within 30 days. Many developed countries are now implementing policies to increase care quality while controlling costs for COPD, known as value-based health care. In the United States, COPD is part of Medicare's Hospital Readmissions Reduction Program (HRRP), which penalizes hospitals for excess 30-day, all-cause readmissions after a hospitalization for an acute exacerbation of COPD, despite minimal evidence to guide hospitals on how to reduce readmissions. This review outlines challenges for improving overall COPD care quality and specifically for the HRRP. These challenges include heterogeneity in the literature for how COPD and readmissions are defined, difficulty finding the target population during hospitalizations, and a lack of literature to guide evidence-based programs for COPD readmissions as defined by the HRRP in the hospital setting. It then identifies risk factors for early readmissions after acute exacerbation of COPD and discusses tested and emerging strategies to reduce these readmissions. Finally, we evaluate the current HRRP and future policy changes and their effect on the goal to deliver value-based COPD care. COPD remains a chronic disease with a high prevalence that has finally garnered the attention of health systems and policy makers, but we still have a long way to go to truly deliver value-based care to patients.
authors.affiliation: Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, IL.
authors.forename: Tina
authors.initials: T
authors.lastname: Shah
authors.affiliation: Section of Hospital Medicine, University of Chicago, Chicago, IL.
authors.forename: Valerie G
authors.initials: VG
authors.lastname: Press
authors.affiliation: Section of Geriatrics and Palliative Medicine, Department of Medicine, University of Chicago, Chicago, IL.
authors.forename: Megan
authors.initials: M
authors.lastname: Huisingh-Scheetz
authors.affiliation: Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, IL. Electronic address: swhite@medicine.bsd.uchicago.edu.
authors.forename: Steven R
authors.initials: SR
authors.lastname: White
mesh_terms: D014487:Centers for Medicare and Medicaid Services, U.S.; D006291:Health Policy; D006760:Hospitalization; D006801:Humans; D010359:Patient Readmission / Q000706:statistics & numerical data*; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy*; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care; D012051:Reimbursement Mechanisms; D018570:Risk Assessment; D014481:United States
keywords: COPD; Medicare Hospital Readmissions Reduction Program (HRRP); acute exacerbation of COPD; emphysema; readmissions