COPD readmissions in an urban environment: health service factors
Admissions for COPD are associated with poor prognosis. COPD readmissions have been proposed as a marker of care quality. Rates of COPD readmission vary depending on age, disease severity and the presence of co-morbidities. A national United Kingdom audit (2008) suggested a COPD readmission rate of 34% within 90 days of discharge. Readmission rates for COPD of between 7% and 20% within 30 days of discharge have been reported in the United States. Little is known of the contribution of patient and health service factors to the risk of COPD readmission. This study aimed to describe the rates of readmission for COPD in patients not admitted in the previous 12 months and to identify associated patient, general practice and hospital factors.
This was a retrospective longitudinal study of all COPD patients registered with London general practices admitted as an emergency with COPD (2006-2010), and not having a COPD admission in the preceding 12 months. The contribution of hospital, general practice, and patient factors, including age, gender and deprivation, to readmission risk was determined by multiple logistic regression.
38504 admissions to 41 hospitals of 22462 patients from 1632 general practices were included. Mean age 72.8 years, 51.7% male. 7772 (34.6%) patients had at least one readmission over the four years. 1752 (7.8%) patients were readmitted within 28 days of discharge, 3998 (17.8%) within 182 days. Longer first admission (OR: 1.007, p<0.001) and patient age (OR: 1.003, p=0.014) were positive predictors of readmission. There was variation in rates of readmission between practices and between hospitals, but risk of readmission was not associated with general practice performance or with admitting hospital.
Readmission for COPD was observed in < 20% of admitted patients not admitted in the previous year. Patient rather than healthcare factors were influential in COPD readmissions. The rate of COPD readmission in COPD has limited value as a marker of care quality.
- Timothy Harries
- Katherine Jackson
- Patrick White