To the Editor:
We thank Drs Glaser and Castellano for their comments on our recent article1 in CHEST concerning predicting 30-day readmissions after acute exacerbation of COPD (AECOPD). Building on our finding that only 27.6% of readmissions were due to AECOPD and that respiratory-related reasons for readmission accounted for 51% of all readmissions, Drs Glaser and Castellano describe results from an analysis of risk factors specific to various reasons for readmission, using data from their teaching hospital, which presumably include all ages and payers, not only Medicare admissions for those age 65 years and older, as in our study.1 Specifically, they looked separately at predictors of readmission for sepsis and AECOPD and found that the risk factors differed.
Patients with COPD are a challenging population in whom to improve health because of diagnostic difficulties and varying presentations of AECOPD. Although the reason for readmission cannot be known in advance, given that most readmissions are not for AECOPD, identifying key risk factors for common reasons for readmission could contribute to strategies that improve trajectories for patients with COPD.
As disease-guideline development is now trending toward consideration of multiple diseases together, we believe successful interventions to curb AECOPD readmission require a holistic approach that spans beyond the focus on respiratory disease. Our findings and those of Drs Glaser and Castellano give further testimony to the need for research to better define AECOPD; to better understand the life cycle of patients hospitalized for AECOPD, starting from a period prior to hospitalization and extending beyond hospital discharge; and to engage more stakeholders in innovative approaches to disseminate information to improve health in patients with AECOPD.
Acknowledgments
Role of sponsors: The funding organizations had no role in the design and conduct of the study; the collection, management, analysis, and interpretation of the data; the preparation, review, or approval of the manuscript; or the decision to submit the manuscript for publication.
Footnotes
FUNDING/SUPPORT: This study was supported by the Agency for Healthcare Research and Quality [Grant AHRQ R21HS021877] and by a National Institutes of Health National Heart, Lung, and Blood Institute Research Training in Respiratory Biology [Grant T32 HL007605]. Dr Churpek has received grant support from the National Institutes of Health [K08 HL121080].
CONFLICT OF INTEREST: None declared.
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.
References
- 1.Shah T, Churpek MM, Coca Perraillon M, Konetzka RT. Understanding why patients with COPD get readmitted: a large national study to delineate the Medicare population for the readmissions penalty expansion. Chest. 2015;147(5):1219-1226. [DOI] [PMC free article] [PubMed] [Google Scholar]