Hospital Readmission Due to Chronic Obstructive Pulmonary Disease: A Longitudinal Study

Document Type : Original Article

Authors

1 School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia

2 School of Nursing and Midwifery, University of Newcastle, Port Macquarie, NSW, Australia

3 Tasmanian School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia

Abstract

Background 
This study aimed to investigate the prevalence of hospital readmission for chronic obstructive pulmonary disease (COPD) at 30, 90 and 365 days, and to determine demographic and socioeconomic risk factors for 30-day and 90-day readmission and time to COPD-related readmission within 365 days in Tasmania.

Methods 
Patients ≥40 years admitted for COPD between 2011 and 2015 were identified using administrative data from all major public hospitals in Tasmania, Australia. Factors associated with readmission and time to readmission were identified using logistic and Cox regression, respectively.

Results 
The rates of COPD-related readmission were 6.7% within 30 days, 12.2% within 90 days and 23.7% within 365 days. Being male (odds ratio [OR]: 1.49, CI: 1.06–2.09), Indigenous (OR: 2.47, CI: 1.31–4.66) and living in the lower socioeconomic North-West region of Tasmania (OR: 1.80, CI: 1.20–2.69) were risk factors for 30-day readmission. Increased COPD-related (OR: 1.48, CI: 1.22–1.80; OR: 1.52, CI: 1.29–1.78) and non-COPD-related (OR: 1.12, CI: 1.03–1.23; OR: 1.11, CI: 1.03–1.21) emergency department (ED) visits in the preceding six months were risk factors for both 30-day and 90-day readmissions. Being Indigenous (hazard ratio [HR]: 1.61, CI: 1.10–2.37) and previous COPD-related ED visits (HR: 1.30, CI: 1.21–1.39) decreased, while a higher Charlson Comorbidity Index (CCI) (OR: 0.91, CI: 0.83–0.99) increased the time to readmission within 365 days.

Conclusion 
Being male, Indigenous, living in the North-West region and previous ED visits were associated with increased risk of COPD readmission in Tasmania. Interventions to improve access to primary healthcare for these groups may reduce COPD-related readmissions.

Keywords

References

  1. Murray CJ, Lopez AD. Alternative projections of mortality and disability by cause 1990-2020: Global Burden of Disease Study. Lancet. 1997;349(9064):1498-1504. doi:1016/s0140-6736(96)07492-2
  2. GBD 2013 Mortality and Causes of Death Collaborators. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;385(9963):117-171. doi:1016/s0140-6736(14)61682-2
  3. Murray CJ, Barber RM, Foreman KJ, et al. Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990-2013: quantifying the epidemiological transition. Lancet. 2015;386(10009):2145-2191. doi:1016/s0140-6736(15)61340-x
  4. Toelle BG, Xuan W, Bird TE, et al. Respiratory symptoms and illness in older Australians: the Burden of Obstructive Lung Disease (BOLD) study. Med J Aust. 2013;198(3):144-148. doi:5694/mja11.11640
  5. Australian Institute of Health and Welfare. Admitted Patient Care 2015-2016: Australian Hospital Statistics. Health Service Series No 75. https://www.aihw.gov.au/reports/hospitals/ahs-2015-2016-admitted-patient-care. Published 2017.
  6. Department of Treasury and Finance. Regional Population Growth 2015–16. Hobart: Tasmania Government; 2017. Australian Bureau of Statistics Cat. No.: 3218.0. http://www.treasury.tas.gov.au/Documents/Regional-Population-Growth.pdf. Accessed February 21, 2020.
  7. Australian Government Department of Health. Rural, Remote and Metropolitan Area. Health Workforce Locator. https://www.health.gov.au/resources/apps-and-tools/health-workforce-locator/health-workforce-locator. Accessed April 22, 2020.
  8. AIHW (Australian Insitute of Health and Welfare) 2018. Potentially preventable hospitalisations in Australia by small geographic areas. Cat. No. HPF 36. Canberra: AIHW. https://www.aihw.gov.au/reports/primary-health-care/potentially-preventable-hospitalisations/contents/overview. Accessed February 4, 2020.
  9. Raghavan D, Bartter T, Joshi M. How to reduce hospital readmissions in chronic obstructive pulmonary disease? Curr Opin Pulm Med. 2016;22(2):106-112. doi:1097/mcp.0000000000000245
  10. Douglas SL, Daly BJ, Gordon N, Brennan PF. Survival and quality of life: short-term versus long-term ventilator patients. Crit Care Med. 2002;30(12):2655-2662. doi:1097/00003246-200212000-00008
  11. Njoku CM, Alqahtani JS, Wimmer BC, et al. Risk factors and associated outcomes of hospital readmission in COPD: a systematic review. Respir Med. 2020;173:105988. doi:1016/j.rmed.2020.105988
  12. McLean R, Mendis K, Canalese J. A ten-year retrospective study of unplanned hospital readmissions to a regional Australian hospital. Aust Health Rev. 2008;32(3):537-547. doi:1071/ah080537
  13. Considine J, Fox K, Plunkett D, Mecner M, O’Reilly M, Darzins P. Factors associated with unplanned readmissions in a major Australian health service. Aust Health Rev. 2019;43(1):1-9. doi:1071/ah16287
  14. Commonwealth of Australia. The Commission on Delivery of Health Services in Tasmania: Report to the Australian Government and Tasmania Government Health Ministers. https://michaelferguson.com/2014/05/report-of-the-commission-on-delivery-of-health-services-in-tasmania/. Accessed June 22, 2020.
  15. Regional Development Australia Tasmania. RDA Tasmania Regional Plan July2017-June2019. Australian Government. https://www.rdatasmania.org.au/client-assets/documents/documents-and-reports/RDA%20Tasmania%20Regional%20Plan_2017%20-%202019%20(FINAL).pdf. Accessed June 22, 2020. Published 2017.
  16. Department of Health and Human Services. Connecting Care: Chronic Disease Action Framework for Tasmania 2009-2013. Hobart: Tasmanian Government, 2009. https://www.dhhs.tas.gov.au/__data/assets/pdf_file/0006/48390/Connecting_Care_Full_Version_web.pdf. Accessed February 28, 2020.
  17. Australian Bureau of Statistics Socio-Economic Indexes for Areas (SEIFA) 2016. http://www.abs.gov.au/websitedbs/censushome.nsf/home/seifa. Accessed June 5, 2020.
  18. Quan H, Sundararajan V, Halfon P, et al. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care. 2005;43(11):1130-1139. doi:1097/01.mlr.0000182534.19832.83
  19. Candrilli SD, Dhamane AD, Meyers JL, Kaila S. Factors associated with inpatient readmission among managed care enrollees with COPD. Hosp Pract (1995). 2015;43(4):199-207. doi:1080/21548331.2015.1085797
  20. González C, Servera E, Ferris G, Blasco ML, Marín J. [Risk factors of readmission in acute exacerbation of moderate-to-severe chronic obstructive pulmonary disease]. Arch Bronconeumol. 2004;40(11):502-507. doi:1016/s1579-2129(06)60365-0
  21. Fuhrman C, Moutengou E, Roche N, Delmas MC. Prognostic factors after hospitalization for COPD exacerbation. Rev Mal Respir. 2017;34(1):1-18. doi:1016/j.rmr.2016.03.012
  22. Roberts MH, Clerisme-Beaty E, Kozma CM, Paris A, Slaton T, Mapel DW. A retrospective analysis to identify predictors of COPD-related rehospitalization. BMC Pulm Med. 2016;16(1):68. doi:1186/s12890-016-0231-3
  23. Chen YJ, Narsavage GL. Factors related to chronic obstructive pulmonary disease readmission in Taiwan. West J Nurs Res. 2006;28(1):105-124. doi:1177/0193945905282354
  24. Gershon AS, Thiruchelvam D, Aaron S, et al. Socioeconomic status (SES) and 30-day hospital readmissions for chronic obstructive pulmonary (COPD) disease: a population-based cohort study. PLoS One. 2019;14(5):e0216741. doi:1371/journal.pone.0216741
  25. Australian Institute of Health and Welfare 2018. Australia's health 2018. Australia’s health series no. 16. AUS 221. Canberra: AIHW; 2018. https://www.aihw.gov.au/reports/australias-health/australias-health-2018/contents/table-of-contents. Accessed July 1, 2020.
  26. MacKichan F, Brangan E, Wye L, et al. Why do patients seek primary medical care in emergency departments? an ethnographic exploration of access to general practice. BMJ Open. 2017;7(4):e013816. doi:1136/bmjopen-2016-013816
  27. Health Indicators Tasmania 2013. Epidemiology Unit, Population Health, Department of Health and Human Services. https://www.dhhs.tas.gov.au/__data/assets/pdf_file/0019/132283/Health_Indicators_Tasmania_2013.pdf. Accessed August 18, 2020.
  28. Australian Institute of Health and Welfare. Coronary heart disease and chronic obstructive pulmonary disease in indigenous Australians. Cat. no. IHW 126. https://www.aihw.gov.au/reports/indigenous-australians/coronary-heart-disease-and-chronic-obstructive. Accessed April 20, 2020. Published 2014.
  29. Zapatero A, Barba R, Ruiz J, et al. Malnutrition and obesity: influence in mortality and readmissions in chronic obstructive pulmonary disease patients. J Hum Nutr Diet. 2013;26 Suppl 1:16-22. doi:1111/jhn.12088
  30. Baker CL, Zou KH, Su J. Risk assessment of readmissions following an initial COPD-related hospitalization. Int J Chron Obstruct Pulmon Dis. 2013;8:551-559. doi:2147/copd.s51507
  31. Chan FW, Wong FY, Yam CH, et al. Risk factors of hospitalization and readmission of patients with COPD in Hong Kong population: analysis of hospital admission records. BMC Health Serv Res. 2011;11:186. doi:1186/1472-6963-11-186
  32. Department of Health and Human Services. Tasmanian Government. Tobacco Control. https://www.dhhs.tas.gov.au/publichealth/tobacco_control/tobacco_control_laws. Accessed May 28, 2020.
  33. Fritschi L, Crewe J, Darcey E, et al. The estimated prevalence of exposure to asthmagens in the Australian workforce, 2014. BMC Pulm Med. 2016;16:48. doi:1186/s12890-016-0212-6
  34. Fish JA, Prichard I, Ettridge K, Grunfeld EA, Wilson C. Understanding variation in men’s help-seeking for cancer symptoms: a semistructured interview study. Psychol Men Masc. 2019;20(1):61-70. doi:1037/men0000152
  35. Hurst JR, Vestbo J, Anzueto A, et al. Susceptibility to exacerbation in chronic obstructive pulmonary disease. N Engl J Med. 2010;363(12):1128-1138. doi:1056/NEJMoa0909883
  36. Wong AW, Gan WQ, Burns J, Sin DD, van Eeden SF. Acute exacerbation of chronic obstructive pulmonary disease: influence of social factors in determining length of hospital stay and readmission rates. Can Respir J. 2008;15(7):361-364. doi:1155/2008/569496
  37. Morley C, Stankovich J, Peterson G, Kinsman L. Planning for the future: emergency department presentation patterns in Tasmania, Australia. Int Emerg Nurs. 2018;38:34-40. doi:1016/j.ienj.2017.09.001
  38. McNab J, Gillespie JA. Bridging the chronic care gap: HealthOne Mt Druitt, Australia. Int J Integr Care. 2015;15:e015. doi:5334/ijic.2243
  39. Epstein D, Nasser R, Mashiach T, Azzam ZS, Berger G. Increased red cell distribution width: a novel predictor of adverse outcome in patients hospitalized due to acute exacerbation of chronic obstructive pulmonary disease. Respir Med. 2018;136:1-7. doi:1016/j.rmed.2018.01.011
  40. Alqahtani JS, Njoku CM, Bereznicki B, et al. Risk factors for all-cause hospital readmission following exacerbation of COPD: a systematic review and meta-analysis. Eur Respir Rev. 2020;29(156):190166. doi:1183/16000617.0166-2019
  41. Australian Institute of Health and Welfare 2020. Australia’s health 2020 data insights. Australia’s Health Series No 17 Cat. no. AUS 231. Canberra: AIHW. https://www.aihw.gov.au/getmedia/be95235d-fd4d-4824-9ade-34b7491dd66f/aihw-aus-231.pdf.aspx?inline=true. Accessed August 13, 2020.
  42. Yang IA, Brown JL, George J, et al. COPD-X Australian and New Zealand guidelines for the diagnosis and management of chronic obstructive pulmonary disease: 2017 update. Med J Aust. 2017;207(10):436-442. doi:5694/mja17.00686
International Journal of Health Policy and Management
Volume 11, Issue 11
November 2022
Pages 2533-2541

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History

  • Receive Date: 07 December 2020
  • Revise Date: 15 September 2021
  • Accept Date: 08 January 2022
  • First Publish Date: 09 January 2022

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