title: Evaluation of prediction strategy and care coordination for COPD readmissions.
abstract: OBJECTIVE
  Factors that influence the likelihood of readmission for chronic obstructive pulmonary disease (COPD) patients and the impact of posthospital care coordination remain uncertain. LACE index (L = length of stay, A = Acuity of admission; C = Charlson comorbidity index; E = No. of emergency department (ED) visits in last 6 months) is a validated tool for predicting 30-days readmissions for general medicine patients. We aimed to identify variables predictive of COPD readmissions including LACE index and determine the impact of a novel care management process on 30-day all-cause readmission rate.
  
  
  METHODS
  In a case-control design, potential readmission predictors including LACE index were analyzed using multivariable logistic regression for 461 COPD patients between January-October 2013. Patients with a high LACE index at discharge began receiving care coordination in July 2013. We tested for association between readmission and receipt of care coordination between July-October 2013. Care coordination consists of a telephone call from the care manager who: 1) reviews discharge instructions and medication reconciliation; 2) emphasizes importance of medication adherence; 3) makes a follow-up appointment with primary care physician within 1-2 weeks and; 4) makes an emergency back-up plan.
  
  
  RESULTS
  COPD readmission rate was 16.5%. An adjusted LACE index of ≥ 13 was not associated with readmission (p = 0.186). Significant predictors included female gender (odds ratio [OR] 0.51, 95% confidence interval [CI] 0.29-0.91, p = 0.021); discharge to skilled nursing facility (OR 3.03, 95% CI 1.36-6.75, p = 0.007); 4-6 comorbid illnesses (OR 9.21, 95% CI 1.17-76.62, p = 0.035) and ≥ 4 ED visits in previous 6 months (OR 6.40, 95% CI 1.25-32.87, p = 0.026). Out of 119 patients discharged between July-October 2013, 41% received the care coordination. The readmission rate in the intervention group was 14.3% compared to 18.6% in controls (p = 0.62).
  
  
  CONCLUSIONS
  Factors influencing COPD readmissions are complex and poorly understood. LACE index did not predict 30-days all-cause COPD readmissions. Posthospital care coordination for transition of care from hospital to the community showed a 4.3% reduction in the 30-days all-cause readmission rate which did not reach statistical significance (p = 0.62).
authors.affiliation: a Department of Medicine , Thomas Jefferson University , Philadelphia , PA , USA.
authors.forename: Babar
authors.initials: B
authors.lastname: Bashir
authors.affiliation: b Department of Medicine , Abington Jefferson Hospital , Abington , PA , USA.|c Center for Patient Safety and Quality , Abington Jefferson Hospital , Abington , PA , USA.
authors.forename: Doron
authors.initials: D
authors.lastname: Schneider
authors.affiliation: b Department of Medicine , Abington Jefferson Hospital , Abington , PA , USA.
authors.forename: Mary C
authors.initials: MC
authors.lastname: Naglak
authors.affiliation: d Department of Radiation Oncology , Fox Chase Cancer Center , Philadelphia , PA , USA.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Churilla
authors.affiliation: c Center for Patient Safety and Quality , Abington Jefferson Hospital , Abington , PA , USA.
authors.forename: Marguerite
authors.initials: M
authors.lastname: Adelsberger
mesh_terms: D000369:Aged, 80 and over; D015897:Comorbidity; D003266:Continuity of Patient Care / Q000458:organization & administration; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010346:Patient Care Management / Q000458:organization & administration*; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data*; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology* / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D012959:Socioeconomic Factors; D013997:Time Factors
keywords: COPD; Health outcomes; LACE index; care coordination; hospital readmissions