Multi-morbidities are Not a Driving Factor for an Increase of COPD-Related 30-Day Readmission Risk
Authors Lin S, Xue H, Deng Y, Chukmaitov A
Received 6 September 2019
Accepted for publication 19 December 2019
Published 15 January 2020 Volume 2020:15 Pages 143—154
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 3
Editor who approved publication: Dr Richard Russell
Shuo-yu Lin, Hong Xue, Yangyang Deng, Askar Chukmaitov
Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
Correspondence: Hong Xue; Askar Chukmaitov
Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, One Capitol Square, 830 East Main Street, Fourth Floor, Richmond, VA 23219, USA
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Background and Objective: Chronic obstructive pulmonary disease (COPD) is the third leading cause of death in the United States. COPD is expensive to treat, whereas the quality of care is difficult to evaluate due to the high prevalence of multi-morbidity among COPD patients. In the US, the Hospital Readmissions Reduction Program (HRRP) was initiated by the Centers for Medicare and Medicaid Services to penalize hospitals for excessive 30-day readmission rates for six diseases, including COPD. This study examines the difference in 30-day readmission risk between COPD patients with and without comorbidities.
Methods: In this retrospective cohort study, we used Cox regression to estimate the hazard ratio of 30-day readmission rates for COPD patients who had no comorbidity and those who had one, two or three, or four or more comorbidities. We controlled for individual, hospital and geographic factors. Data came from three sources: Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SID), Area Health Resources Files (AHRF) and the American Hospital Association’s (AHA’s) annual survey database for the year of 2013.
Results: COPD patients with comorbidities were less likely to be readmitted within 30 days relative to patients without comorbidities (aHR from 0.84 to 0.87, p < 0.05). In a stratified analysis, female patients with one comorbidity had a lower risk of 30-day readmission compared to female patients without comorbidity (aHR = 0.80, p < 0.05). Patients with public insurance who had comorbidities were less likely to be readmitted within 30 days in comparison with those who had no comorbidity (aHR from 0.79 to 0.84, p < 0.05).
Conclusion: COPD patients with comorbidities had a lower risk of 30-day readmission compared with patients without comorbidity. Future research could use a different study design to identify the effectiveness of the HRRP.
Keywords: multi-morbidities, readmission, gender difference, health insurance, all-payer claims databases
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