Study Finds Chronic Care Management Collaborative Can Reduce COPD-Related Revisits

A study published in the Journal of the COPD Foundation found that a chronic obstructive pulmonary disease (COPD) care management collaborative, developed by Vizient, was effective in reducing hospital revisits from patients with COPD.

The collaborative focused on assisting with the implementation of COPD care management strategies, standard practices, and evidence-based protocols to help reduce progression and readmission for patients with COPD. The collaborative consisted of 2 parts, and participants could participate in one or both parts:

• Part 1 focused on improving effective care management and care access
• Part 2 focused on exploring the strategies to incorporate standard practices of care and protocols.

The goals of the collaborative included increasing patient engagement, education, and long-term self-management; establishing community and post-acute care partnerships; identifying population health management strategies; and improving interprofessional team collaboration, COPD-related knowledge, and standardization of workflows and processes.

Each site using this collaborative chose to implement the interventions that would fill a gap in care quality for patients hospitalized with COPD. Some of these interventions included developing a core interdisciplinary COPD team, having a standardized discharge process, and implementing COPD care pathways.

Process improvements were evaluated by population reach of an intervention, defined as the number of individuals affected by a program initiative using the aforementioned intervention measures. Annualized avoided costs were quantified by estimating the average cost of inpatient readmission. Statistics summarized quantitative data using means, medians, SD, IQR, and proportions.

The collaborative ran from September 2019 to February 2020; part 1 ran from September to November, and part 2 ran from December to February. There were 47 members who enrolled, with 33 joining for the whole collaborative, 3 for part 1, and 11 for part 2. Eight of the participants were from the Southeast, 4 from the Southwest, 21 from the Midwest, 12 from the Northern Coast, and 2 from the Northwest. There were 22 hospitals with fewer than 250 beds, 15 hospitals with 251 to 451 beds, and 10 hospitals with more than 500 beds.

Of the participants who submitted data (n = 23):

• 83% of the hospitals reduced their COPD-related emergency department (ED) revisits and/or hospital readmissions
• 5 reduced both ED revisits and hospital readmissions
• 7 reduced ED revisits
• 7 reduced hospital readmissions
• 4 hospitals did not improve in either outcome

In the 23 hospitals, ED visits were reduced from 11.05% to 10.87% (mean 29%), but there were no reductions in hospital readmissions (18.53% to 18.64% [mean 29%]). In the 7 hospitals that had reductions in ED visits, the total fell from 12.7% to 9% and the readmission rate from 20.1% to 15.6%.

Overall, 68% of the hospitals with improvement in ED and/or hospital revisits had greater than 80% participation in the collaborative. Among the hospitals that did not see decreases in ED visits or hospitalization, only 50% had participation greater than 80%.

The mean (SD) reach of the most successful measures of each hospital was 35.2% (26.7%) at baseline and 73.8% (18.3%) at follow-up. Hospitals in the top quartile who participated in parts 1 and 2 had a mean reach of 81% vs hospitals in the bottom quartile at 9.82%.

The cost avoidance for hospitals that reduced ED visits for patients with COPD was $351,157.30 and readmission was $2,534,833. The collaborative group avoided 183 ED visits and 176 hospital readmissions.

There were some limitations to this study. The collaborative did not randomize sites and each site chose its own interventions, which could limit generalizability. The interventions were implemented at each site without piloting a single site first. Participation bias may be present, both in the joining of the collaborative and in participation. Half of the sites did not provide complete data, which may provide bias in results.

“The Vizient COPD Collaborative was able to demonstrate improved outcomes and cost savings by supporting diverse US hospitals to develop and implement COPD readmission reduction programs,” wrote the researchers.

They concluded that the collaborative may assist US hospitals to reduce preventable and costly acute care utilization and wrote that future work can further obtain important evidence of the impact of collaboratives to support implementations of similar initiatives.

Reference

Press VG, Randall K, Hanser A. Evaluation of COPD chronic care management collaborative to reduce emergency department and hospital revisits across U.S. hospitals. Chronic Obstr Pulm Dis. Published online March 23, 2022. doi:10.15326/jcopdf.2022.0273