R. S. Chamberlain1,2,3, C. S. Lau1,2, B. L. Siracuse1, R. S. Chamberlain1,2,3 1Saint Barnabas Medical Center,Surgery,Livingston, NJ, USA 2Saint George’s University,Grenada, Grenada, Grenada 3Rutgers University,Surgery,Newark, NEW JERSEY, USA
Background: Chronic obstructive pulmonary disease (COPD) or emphysema affects over 13 million Americans, accounts for over 500,000 hospitalizations annually, and is a frequent co-morbidity in surgical patients, altering or curtailing surgical therapy. The Hospital Readmission Reduction Program, established by the ACA requires the Centers for Medicare and Medicaid Services to reduce payments to hospitals with excess readmissions for COPD as of 2015. This study sought to develop a predictive readmission nomogram that could identify COPD patients at higher readmission risk, as well as surgical risk, and permit the implementation of readmission risk reduction strategies a priori.
Methods: Demographic and clinical data on 342,907 patients from New York and California (derivation cohort) and 260,553 patients from Washington and Florida (validation cohort) were abstracted from the State Inpatient Database (2006-2011), and the Readmission After Chronic Obstructive Pulmonary Disease Exacerbation (RACE) Scale was developed to predict 30-day readmission risk.
Results: 30-day COPD readmission rates were 7.50% for the derivation cohort and 6.67% for the validation cohort. Factors including age <65 (OR 1.58; 95% CI, 1.50-1.67), male gender (OR 1.15; 95% CI, 1.12-1.18), African American (OR 1.09; 95% CI, 1.05-1.14), 1st income quartile (OR 1.09; 95% CI, 1.05-1.14), Medicare (OR 1.49; 95% CI, 1.41-1.56), Medicaid (OR 1.84; 95% CI, 1.74-1.95), anemia (OR 1.07; 95% CI, 1.03-1.11), congestive heart failure (OR 1.08; 95% CI, 1.05-1.12), depression (OR 1.17; 95% CI, 1.13-1.22), drug abuse (OR 1.16; 95% CI, 1.08-1.23), and psychoses (OR 1.17; 95% CI, 1.12-1.23) were independently associated with increased readmission rates, p<0.01. The RACE Scale was created. When it was applied to the validation cohort, it explained 94% of readmission variability within the cohort.
Conclusions: The RACE Scale reliably predicts an individual patient’s 30-day COPD readmission risk based on specific factors present at initial admission. The RACE Scale is a risk stratification model that can identify high-risk patients and permit implementation of patient-specific readmission-reduction strategies to improve patient care, surgical outcomes, as well as reducing readmissions and healthcare expenditures.
