Chronic Obstructive Pulmonary Disease Readmissions and Other Measures of Hospital Quality

Abstract

Rationale: The Centers for Medicare and Medicaid Services recently implemented financial penalties to reduce hospital readmissions for select conditions, including chronic obstructive pulmonary disease (COPD). Despite growing pressure to reduce COPD readmissions, it is unclear how COPD readmission rates are related to other measures of quality, which could inform efforts on common organizational factors that affect high-quality care.

Objectives: To examine the association between COPD readmissions and other quality measures.

Methods: We analyzed data from the 2015 Centers for Medicare and Medicaid Services annual files, downloaded from the Hospital Compare website. We included 3,705 hospitals nationwide that had publically reported data on COPD readmissions. We compared COPD readmission rates to other risk-adjusted measures of quality, including readmission and mortality rates for other conditions, and patient reports about care experiences.

Measurements and main results: There were modest correlations between COPD readmission rates and readmission rates for other medical conditions, including heart failure (r = 0.39; P < 0.01), acute myocardial infarction (r = 0.30; P < 0.01), pneumonia (r = 0.38; P < 0.01), and stroke (r = 0.29; P < 0.01). In contrast, we found low correlations between COPD readmission rates and readmission rates for surgical conditions, as well as mortality rates for all measured conditions. There were significant correlations between COPD readmission rates and all patient experience measures.

Conclusions: These findings suggest there may be common organizational factors that influence multiple disease-specific outcomes. As pay-for-performance programs focus attention on individual disease outcomes, hospitals may benefit from in-depth assessments of organizational factors that affect multiple aspects of hospital quality.

Keywords: chronic obstructive pulmonary disease; health care; patient readmission; quality indicators.

Figure 1.

Correlation between risk-adjusted readmission for chronic obstructive pulmonary disease (COPD) and readmission for (A) heart failure, (B) acute myocardial infarction (AMI), (C) pneumonia, (D) stroke, (E) coronary artery bypass graft (CABG) surgery, and (F) hip/knee surgery. The line represents a linear regression, the shaded area the 95% confidence interval of the fit, and the gray dots represent data points (light gray indicates points without overlapping scores, and dark gray indicates multiple data points with the same values).

Figure 2.

Correlation between risk-adjusted readmission for chronic obstructive pulmonary disease (COPD) and mortality for (A) heart failure, (B) acute myocardial infarction (AMI), (C) pneumonia, (D) stroke, (E) coronary artery bypass graft (CABG) surgery, and (F) COPD. The line represents a linear regression, the shaded area the 95% confidence interval of the fit, and the gray dots represent data points (light gray indicates points without overlapping scores, and dark gray indicates multiple data points with the same values).

Figure 3.

Percentage of hospitals that had a Hospital Consumer Assessment of Healthcare Providers and Systems Achievement score of zero (i.e., that did not meet the Achievement threshold) for multiple domains in the lowest chronic obstructive pulmonary disease readmission quartiles versus highest chronic obstructive pulmonary disease readmission quartiles.