No resident likes to see their patients readmitted to the hospital. And now the US government (through Centers for Medicare & Mecicaide Services) added COPD to the Readmission Reduction Program for FY 2015. This means that hospitals will have to pay $$$ for any COPD readmissions. So the question is: Can we reduce the risk of readmission for a patient with COPD exacerbations?
The Cleveland Clinic Journal of Medicine published an article with an answer to this question (link). In a nutshell, there are a few things that are shown to decrease COPD readmissions.
- Smoking cessation: Which decreases exacerbation. No studies on readmissions though.
- Influenza and pneumococcal vaccines: Multiple studies show that this is effective.
- Long-term O2: For those with chrnoic resting hypoxemia. with PaO2 less than or equal
- Home exercise or pulomnary rehab: Systemic review of six trials showed a RR of 0.26 (95% CI 0.12-0.54)
- Patient education, including proper inhaler technique: Decreases readmissions in select patients.
- Consider home non-invasive ventilator support
Other things to consider include referral to pulmonologist, roflumilast therapy, long term antibiotic use (though not recommended by GOLD guidlines because this increases antibioitic resistance).
If you have 45-60 seconds to spare, I highly recommend reviewing Table 1 in this article.