How to Avoid COPD Rehospitalization

Follow up care with pulmonologist crucial to health outcomes.

For patients hospitalized for chronic obstructive pulmonary disease (COPD) related complications, failing to see pulmonologists after discharge was found to increase readmission risk threefold, researchers reported in CHEST.

According to an American College of Chest Physicians press release, COPD accounts for a large portion of hospital activity (500,000 admissions) and health care costs ($18 billion) annually. Previous evidence has shown that re-hospitalization for this condition is common; with more than half of COPD patients who are already treated will be treated again within a year, 14% will be readmitted a month following discharge, and 7% after three months.

For their study, the team assessed data of every patient admitted to an Israeli hospital for a COPD-related issue from Jan. 1, 2004, through Dec. 31, 2010. To gauge the influence a pulmonologist has in re-hospitalization outcomes, they followed patients who did not see a specialist within 90 days of being released. The researchers also created a profile of the typical COPD patient who didn’t have a follow-up appointment.

Of the 195 enrolled patients, the researchers reported 44.1% had a visit with their pulmonologist within 30 days of discharge. Moreover, they found not following-up within 90 days was associated with notably higher readmission likelihood (OR, 2.91; 95% CI, 1.06-8.01).

The authors also characterized typical COPD patients who aren’t as likely to see a pulmonologist after hospitalization: they lived more than 18 miles from their doctor and had many hospital visits the previous year. Conversely, individuals who received written recommendations at discharge or pre-hospital admission or had visited a pulmonologist prior to treatment were more likely have an appointment with a specialist.

"The potential impact of this study on reducing the admission rate of patients with common respiratory diseases is high. Advising a patient to visit a chest physician after discharge may save the next admission and reduce the morbidity burden of this serious disease," the study author, Nimrod Maimon, MD, Department of Medicine and the Pulmonology Institute of Soroka and Ben-Gurion University Medical Center, said in a statement.