Implementation of the Hospital Readmission Reduction Program (HRRP), which was created by the Centers for Medicare & Medicaid Services, was associated with a decrease in 30-day readmissions in patients with chronic obstructive pulmonary disease (COPD) following their hospital discharge, according results of an analysis published in the American Journal of Respiratory and Critical Care Medicine.

Investigators conducted a retrospective cohort study on readmission and mortality rates in a national cohort of Medicare fee-for-service beneficiaries between 2006 and 2017.

The purpose of the study was to explore the relationship between 30-day risk-standardized all-cause hospital readmission rates and 30-day risk-standardized all-cause postdischarge mortality in Medicare beneficiaries with COPD during 3 overlapping time periods: (1) pre-announcement period: a 4-year baseline period preceding the official initiation of the HRRP program; (2) announcement period: a 4-year period of announcement for COPD; and (3) implementation period: a 3-year period of the established HRRP for COPD.

Between December 2006 and November 2017, a total of 4,587,542 admissions of Medicare fee-for-service beneficiaries aged ≥65 years with COPD occurred. Of these patients, 97% were discharged alive. Of the discharged patients, 5.3% died within 30 days of discharge. The mean patient age was 77±7 years. Overall, 57% of the patients were men; 86% were White, 8.9% were Black, and 2% were Hispanic.


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Study results showed that the 3-day readmission rate decreased from 20.54% in the pre-announcement period (ie, December 2006 through July 2008) to 18.74% in the implementation period (ie, May 2016 through November 2017). Mortality rates at

30 days were 6.91%, 6.59%, and 7.30% in the pre-announcement, announcement, and implementation periods, respectively.

A major limitation of the current study was the fact that the data source — that is, 100% Medicare beneficiary study files — included only fee-for-service inpatient claims (MedPAR), not Medicare Part B claims. Therefore, the sample was not representative of all Medicare beneficiaries. Moreover, the patient comorbidities used in the risk standardization were underestimated.

The investigators concluded that additional research is warranted to verify the findings from this study and to determine the factors associated with increased mortality rates in patients with COPD in the HRRP implementation period. They also reported that teaching hospitals and hospitals with a >1 nurse-per-bed ratio had a lower 30-day postdischarge mortality rate in the latter part of the HRRP implementation period.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Puebla Neira DA, Hsu ES, Kuo Y-F, Ottenbacher KJ, Sharma G. Readmissions reduction program, mortality and readmissions for chronic obstructive pulmonary disease. Am J Respir Crit Care Med. Published online September 1, 2020. doi:10.1164/rccm.202002-0310OC