Category: Professional Posters
Purpose: In 2015, the Center of Medicare and Medicaid Services began withholding reimbursement to hospitals for all-cause 30-day unplanned hospital readmissions for chronic obstructive pulmonary disease (COPD) exacerbation. The national rate for unplanned 30-day all-cause COPD exacerbation readmission is estimated at 19.6%. Previous studies evaluating the impact of a pharmacist’s intervention on COPD management were predominantly conducted in the outpatient setting. Pharmacist provided patient education on inhaler technique improves adherence and health-related quality of life. The current study aims to determine the impact of a pharmacist-driven transitions of care (TOC) intervention on patient-specific outcomes in patients with COPD exacerbation.
Methods: This institutional review board approved quasi-experimental, single-center, cohort study included adult patients admitted to an internal medicine service for a documented COPD exacerbation from January 2014 to December 2015 (pre-TOC group) and August 2017 to December 2018 (post-TOC group). No TOC program was available for the pre-TOC group. A multi-component TOC program was implemented in August 2017 that included: medication and general disease state counseling prior to hospital discharge, phone call follow-up at 15 days post-discharge to assess general disease state and medication issues, and a phone call or mailed survey at 30 days post-discharge to perform a COPD Assessment Test (CAT) questionnaire. Informed consent was obtained from all included patients in the post-TOC group. Results of the CAT questionnaire were used to assess maintenance medication appropriateness; the patient’s provider was contacted with proposed medication regimen adjustments if opportunities were present for optimization. The primary outcome was time to 180-day COPD-related readmission. Secondary outcomes included rate of 30- and 180-day all-cause and COPD-related readmissions and maintenance medication recommendation acceptance rates. Data were collected from date of hospital admission until 180 days post-discharge. Data were analyzed using Chi-square or Fisher’s exact test for categorical data and Student’s t-test or Wilcoxon rank-sum test for continuous data.
Results: Three hundred thirty-four unique patient encounters were included [220 patients (65.8%) in the pre-TOC group and 114 patients (34.2%) in the post-TOC group]. One hundred forty-three patients were enrolled in the post-TOC group; however, 29 patients were unable to be contacted for at least one component of the TOC program. One hundred and two patients and 93 patients completed the day 15 and day 30 TOC program components, respectively. Therefore, the overall response rate for the post-TOC group was 79.7%. The median time to 180-day COPD-related readmission was not significantly different between groups (74.5 days [IQR 33.5-112.5] vs. 54 days [21-104]; P=0.41). There were no significant differences in 30-day all-cause readmission rate (15.9% vs. 14%; P=0.62) and 30-day COPD-related readmission rate (7.3% vs. 7%; P=0.92). The rate of 180-day all-cause readmissions was not significantly different between groups (38.6% vs. 34.3%; P=0.4); however, the 180-day COPD-related readmission rate was significantly lower in the post-TOC group (31.8% vs. 21.7%; P=0.035). The median CAT score for post-TOC patients completing the 30-day questionnaire was 17.5 (IQR 4.75-25), indicating most patients were COPD Group D (80/93; 86%). Forty-eight medication recommendations were made based on CAT score results and 8 (15.7%) were accepted.
Conclusion: No difference in time to 180-day COPD-related readmission and rates of 30-day all-cause and COPD-related readmissions was found. A significant decrease in 180-day COPD-related readmission rates was found with the implementation of a pharmacist-driven COPD TOC program. Opportunities for optimized maintenance medication prescribing were identified in a majority of included patients. Future research efforts should identify interventions to improve 30-day readmission rates and optimize maintenance medication therapy for patients at the time of hospital discharge.