Online Program

Effects of a post-discharge COPD clinic on readmissions among veterans with COPD exacerbations

Tuesday, November 3, 2015 : 4:50 p.m. - 5:10 p.m.

Nina Bracken, MSN, ACNP-BC, Breathe Chicago Center, College of Medicine, Chicago, IL
Lourdes Norwick, RN, University of Illinois at Chicago, Chicago, IL
H. Ari Jaffe, MD, Jesse Brown VA Medical Center, Chicago, IL
Joshua Hauser, MD, Northwestern University Feinberg School of Medicine, Chicago, IL
Valentin Prieto-Centurion, MD, University of Illinois at Chicago, Chicago, IL
Farhan Zaidi, MD, University of Illinois at Chicago, Chicago, IL
Jerry Krishnan, MD, PhD, Department of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois at Chicago, Chicago, IL
Background: Chronic obstructive pulmonary disease (COPD) results in 700,000 hospitalizations per year, with about 20% of patients readmitted within 30 days.  The objective of this report is to summarize readmission rates before and after the implementation of a post-discharge COPD clinic at a veteran’s affairs hospital. 

Methods: The Jesse Brown Veterans Affairs Hospital in Chicago, Illinois, implemented a quality improvement (QI) program to reduce the number of avoidable readmissions in patients hospitalized with COPD exacerbations (Recovering Obstructive Lung Disease [ROLD] clinic).  The ROLD clinic consists of 3 visits over 4 weeks and features an integrated care model with pulmonary and palliative care physicians, nurses, nurse practitioners, social workers, pharmacists and: (1) a standardized post-discharge clinical evaluation, including medication reconciliation; (2) optimization of medical therapy for COPD; (3) spirometry and O2 evaluation; (4) literacy-appropriate education, including use of medications and inhalers; (5) smoking cessation advice and referral; (6) referrals to pulmonary rehabilitation, social work, and other follow up as needed; and (7) coordination with primary healthcare provider.

Results: Of 127 patients referred to the ROLD program clinic over 18 months, 60% attended at least 1 appointment. Among patients who attended at least 1 post-discharge ROLD program appointment, the 30-day readmissions rate was 12%. Compared to the 12 months prior to the ROLD clinic, the 30-day all-cause readmission rate for all patients hospitalized with COPD exacerbations dropped 5% (from 19% to 14%). 

Conclusion: An intensive interdisciplinary post-discharge COPD clinic greatly reduces the need for readmissions among veterans.  Whether less resource intensive approaches are also effective deserves study.

Learning Areas:

Chronic disease management and prevention
Implementation of health education strategies, interventions and programs
Planning of health education strategies, interventions, and programs
Provision of health care to the public

Learning Objectives:
Describe clinical characteristics of patients recently hospitalized for COPD exacerbations Describe readmission rates before and after implementation of a post-discharge COPD clinic

Keyword(s): Patient-Centered Care, Chronic Disease Management and Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I currently serve as the Clinical and Research Program Manager for the Breathe Chicago Center© and the Population Health Sciences Program at the University of Illinois at Chicago. My research interests involve health services research dedicated to improving health care delivery and patient outcomes across the health system. I also currently practice at the Jesse Brown Veterans Administration in the Recovering Obstructive Lung Disease Clinic, a post-discharge, multi-disciplinary care coordination clinic for COPD patients.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.