Jeannette Y. Wick, RPh, MBA, FASCP
COPD patients who engaged in any amount of moderate to vigorous physical activity after hospitalization had significantly reduced rates of readmission, according to the results of a new study.
Since late 2012, the Centers for Medicare & Medicaid Services (CMS) has calculated and published each hospital’s 30-day risk-standardized readmission rate for heart failure, acute myocardial infarction, and pneumonia. In addition, CMS has imposed financial penalties facilities on hospitals with higher-than-expected readmission rates. When CMS initiated this project, approximately 20% of Medicare recipients were being readmitted to the hospital within 30 days of discharge, and the program was designed to keep more beneficiaries at home and healthy.
To improve care—and avoid negative financial repercussions—performance improvement departments across the nation have looked at ways to improve readmission scores. Care coordination, care transitions, and outpatient management following discharge have focused on educating patients. Key interventions include teaching patients about medication self-management and red flags that signal impending problems; acknowledging patient preferences to improve treatment adherence; and providing appropriate follow-up care by primary care providers and specialists. More than a year after the program launched, readmission rates remain elevated at some facilities and researchers continue to look for new approaches to improve patients’ health.
In 2015, CMS will add chronic obstructive pulmonary disease (COPD) to the list of conditions scrutinized for 30-day readmissions. To augment readmission risk prediction models used in other medical specialties, pulmonologists are searching for modifiable factors that increase the likelihood that COPD patients will return to the hospital. Researchers from Kaiser Permanente Southern California believe physical inactivity is one such factor.
Their retrospective cohort study
, published online on April 8, 2014, in the Annals of the American Thoracic Society
, looked at the relationship between regular physical activity and 30-day readmission rates in 4596 patients with COPD who had an average age of 72.
The study included all patients hospitalized for COPD at a large integrated health system and discharged between January 1, 2011, and December 31, 2012. Because COPD patients are often readmitted for comorbid conditions, the researchers used 30-day all-cause readmission as the primary endpoint. Clinicians assessed each patient’s regular physical activity during outpatient visits and recorded it in terms of total minutes of moderate or vigorous physical activity per week (MVPA).
Overall, the 30-day readmission rate was 18%. Of the readmissions, 60% occurred within 15 days of discharge. Patients who reported MVPA in any amount were significantly less likely to be readmitted within 30 days than were patients who reported no activity, with a relative risk of 0.67.
The researchers also the following independent predictors of readmission: anemia, prior hospitalizations, longer lengths of stay, more comorbidities, a new oxygen prescription at discharge, emergency department use, and living alone.
Lower physical activity is often a reflection of more severe COPD, which the researchers recognize in their conclusion. Nonetheless, they note that promoting and supporting physical activity may be a viable strategy to reduce readmission risk.
Ms. Wick is a visiting professor at the University of Connecticut School of Pharmacy and a freelance writer from Virginia.