Care Quality for Patients with Chronic Obstructive Pulmonary Disease in the Readmission Penalty Era

Am J Respir Crit Care Med. 2022 Aug 2. doi: 10.1164/rccm.202203-0496OC. Online ahead of print.

Abstract

Rationale: COPD is the 5th-leading cause of admissions and third-leading cause of readmissions among US adults. Recent policies instituted financial penalties for excessive COPD readmissions.

Objectives: To evaluate changes in the quality of care for patients hospitalized for COPD following implementation of the Hospital Readmissions Reduction Program (HRRP).

Methods: Retrospective cohort study of patients older than 40 years hospitalized for COPD across 995 US hospitals (Premier Healthcare Database).

Measurements and main results: Quality of care before and after HRRP implementation was measured via adherence to recommended inpatient care treatments for acute exacerbations of COPD (recommended care, non-recommended care, "ideal care" [all recommended and no non-recommended care]). We included 662,842 pre-HRRP January 2010- September 2014) and 285,508 post-HRRP (October 2014- December 2018) admissions. Recommended care increased at a rate of 0.16% per-month pre-HRRP and 0.01% per-month post-HRRP (p<0.001). Non-recommended care decreased at a rate of 0.15% per-month pre-HRRP and 0.13% per-month post-HRRP. Ideal care increased at a rate of 0.24% per-month pre-HRRP and 0.11% per-month post-HRRP (p<0.001).

Conclusions: The pre-HRRP trends toward improving care quality for inpatient COPD care slowed post-HRRP implementation. This suggests that financial penalties for readmissions did not stimulate higher quality of care for patients hospitalized with COPD. It remains unclear what policies or approaches will be effective to ensure high care quality for patients hospitalized with COPD exacerbations.

Keywords: Health Policy; Patient Readmission; Pulmonary Disease, Chronic Obstructive; Quality of Health Care.