Predictors of early readmission among patients 40 to 64 years of age hospitalized for chronic obstructive pulmonary disease

Abstract

Rationale: Various causes can contribute to the high rates of readmission among patients hospitalized with chronic obstructive pulmonary disease (COPD).

Objectives: To determine the frequency and predictors of early readmission among patients aged 40-64 years, hospitalized with COPD.

Methods: In a retrospective cohort study, using a large national commercial insurance database, we obtained the clinical information within 12 months of the index hospitalization and 30 days after discharge.

Measurements and main results: Primary outcome was early readmission, defined as hospitalization within 30 days of discharge. We categorized predictor variables as patient, provider, and system factors, and compared these variables between patients readmitted and those not readmitted. Logistic regression was used for multivariable analysis. Of 8,263 patients who met the inclusion criteria, 741 (8.9%) had early readmission. Multivariable analysis showed patient factors (male, history of heart failure, lung cancer, osteoporosis, and depression), provider factors (no prior prescription of statin within 12 mo of the index hospitalization and no prescription of short-acting bronchodilator, oral steroid and antibiotic on discharge), and system factors (length of stay, <2 or >5 d and lack of follow-up visit after discharge) were associated with early readmission among patients hospitalized with COPD. The C-statistic of the model including patient characteristics was 0.677 (95% confidence interval, 0.656-0.697), which was improved to 0.717 (95% confidence interval, 0.702-0.732) after addition of provider- and system-based factors.

Conclusions: One of 11 patients hospitalized with COPD is readmitted within 30 days of discharge. Provider and system factors are important modifiable risk factors of early readmission.

Keywords: chronic obstructive pulmonary disease; follow-up visit; hospital readmission.

Figure 1.

Establishment of a cohort of patients 40–64 years of age and hospitalized between 2009 and 2011 with a primary diagnosis of chronic obstructive pulmonary disease (COPD). dx = diagnosis; ICD-9 = International Classification of Diseases, Ninth Revision.

Figure 2.

Distribution of early readmission among patients 40–64 years of age and hospitalized with chronic obstructive pulmonary disease between 2009 and 2011.