Follow up lowers readmissions, return ED visits for COPD patients

Chronic obstructive pulmonary disease (COPD) patients who had a follow-up visit shortly after hospital discharge were less likely to visit the ED or be readmitted within 30 days than those without follow up, a new study found.

In a retrospective cohort study, researchers used enrollment and claims data from 62,746 Medicare patients who were hospitalized for COPD at least once between 1996 and 2006. For patients with more than one admission, the researchers randomly selected one admission per patient per year. All patients had an identifiable primary care provider (PCP), meaning they had visited that PCP three or more times in the year before hospitalization.

The researchers used Cox proportional hazard regression with time-dependent covariates to determine the risk of 30-day ED visit and readmission for patients with or without a follow-up visit to their PCP or pulmonologist within 30 days of discharge. About 74% of patients were exclusively treated by their PCP, while 26% were co-treated with a pulmonologist in the year before hospitalization. Results were published in the October 11 Archives of Internal Medicine.

Sixty-seven percent of patients with COPD had an outpatient visit with their PCP or pulmonologist within 30 days of discharge (that percentage increased from 65% in 1996 to 71% in 2006, P<.001). Among those who had follow-up, 86.7% occurred with a PCP, 6.7% with a pulmonologist, and 6.6% with both. Patients who had no follow-up visit were more likely to have a longer length of hospital stay, be older than 85 years, have multiple comorbidities, be black and be admitted through the ED. Receiving care at a large hospital or teaching hospital, and/or in a city, was also associated with less follow up.

The 30-day rate of postdischarge ED visits in patients with follow up was 21.7% compared to 26.3% for non-follow up patients (P<.001). Thirty-day readmissions were 18.9% for the follow-up patients and 21.4% patients without follow up (P<.001). Of those readmitted, the top three reasons were COPD, pneumonia or respiratory infection, and heart failure. In a multivariate, time-dependent analysis, follow-up visits were associated with 14% fewer ED visits (hazard ratio [HR], 0.86; 95% CI, 0.83-0.90) and 9% fewer readmissions (HR, 0.91; 95% CI, 0.87-0.96).

The results suggest discharge planning that emphasizes early outpatient follow up may reduce readmissions for COPD patients, and that planners should pay particular attention to older and/or black adults, and those with multiple comorbidities, the study authors said. Study limitations include that some patients may have had follow-up visits with non-PCP/pulmonologist clinicians; that information on quality of care during hospitalization wasn't taken into account; and that the observational design means associations could come from confounding variables, the authors noted.