Assessment of COPD Overdiagnosis as an Important Factor in COPD Readmission

S. Pandey, S. Ojha
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Abstract

Introduction: The Hospital Readmission Reduction Program (HRRP) was established in 2012 to improve health care by linking payment to the quality of hospital care. Readmission is considered a hospital care quality measure. Under the program, hospitals are penalized for Chronic Obstructive Pulmonary Disease (COPD) readmission, which incentivizes improved care to avoid financial penalties. The effect of COPD overdiagnosis on COPD readmission has not been studied. Objective: The study aims to assess the effect of COPD overdiagnosis in outpatient and inpatient settings on hospital COPD readmissions. Methods: We conducted a retrospective study and examined outpatient and inpatient settings for COPD overdiagnosis. In the outpatient setting, we collected all COPD referrals to our clinic and reviewed charts to determine if those patients had COPD or an alternate diagnosis after our workup. We also studied 3-year inpatient data from January 2015 to March 2018 on hospital readmissions and extracted COPD readmissions. For patients seen by a pulmonary provider in our clinic, we studied patients’ pulmonary function test/ spirometry results and charts and determined if they had a true COPD diagnosis or an overdiagnosis. We also assessed the effect of COPD overdiagnosis on inflation of COPD readmission numbers. Results: Of patients referred to our clinic, 46% did not have COPD on our workup. Among inpatients, our results revealed that preventing COPD overdiagnosis could have reduced admissions attributable to COPD by 22.6%. Conclusion: Correct diagnosis using the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria is an inexpensive way for hospitals to avoid readmission penalties.
COPD过度诊断是COPD再入院的重要因素
导语:2012年制定了减少医院再入院方案(HRRP),通过将支付与医院护理质量挂钩来改善医疗保健。再入院被认为是医院护理质量的衡量标准。根据该计划,医院对慢性阻塞性肺疾病(COPD)的再入院进行处罚,以激励改善护理以避免经济处罚。COPD过度诊断对COPD再入院的影响尚未得到研究。目的:本研究旨在评估门诊和住院慢性阻塞性肺病过度诊断对住院慢性阻塞性肺病再入院的影响。方法:我们进行了一项回顾性研究,并检查了COPD过度诊断的门诊和住院情况。在门诊情况下,我们收集了所有转介到我们诊所的慢性阻塞性肺病患者,并检查了图表,以确定这些患者在我们的检查后是否患有慢性阻塞性肺病或其他诊断。我们还研究了2015年1月至2018年3月住院患者的再入院数据,并提取了COPD再入院数据。对于在我们诊所就诊的肺科医生的患者,我们研究了患者的肺功能测试/肺活量测定结果和图表,并确定他们是否有真正的COPD诊断或过度诊断。我们还评估了COPD过度诊断对COPD再入院人数膨胀的影响。结果:转介到我们诊所的患者中,46%在我们的检查中没有COPD。在住院患者中,我们的研究结果显示,预防COPD过度诊断可使COPD住院率降低22.6%。结论:使用全球慢性阻塞性肺疾病倡议(GOLD)标准进行正确诊断是医院避免再入院处罚的一种廉价方法。
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