Table.

Interventions aimed at reducing readmissions and/or evaluating associated costs

Authors	Title	Population	Study design	Intervention	Outcomes-utilization	Outcomes-costs	Outcomes-other
Not bundled
**Coughlin, et al40	Cost Savings from Reduced Hospitalizations with Use of Home Noninvasive Ventilation for COPD	Patients with severe COPD in the US	Economic model	Home NIV	N/A	Cost savings at 30 and 90 days	N/A
**Silver PC, et al. A52	Respiratory Therapist Disease Management Program for Subjects Hospitalized With COPD	Patients with spirometry confirmed COPD >18 to <65 years at high risk for readmission N=478	RCT	Respiratory Therapists	6 month ED visits/Rehospitalizations combined and separate: No difference for combined ED and hospitalization (p=0.8); no difference for COPD-related or all-cause ED visit (NS); mult non-hosp ED visits fewer in intervention group (p=0.001); at least one COPD admission (p=0.04) and multiple readmission (p=0.02)	N/A	N/A
**Agarwal A, et al.49	Process and Outcome Measures among COPD Patients with a Hospitalization Cared for by an Advance Practice Provider or Primary Care Physician	Medicare patients with at least one hospitalization in 2010 n=7257	Cross sectional retrospective cohort study	Provider type (primary care/APP)	Admissions (NS); 30 day readmissions (NS); AAP patients lower rates of ED visits	N/A	Process measures: APP patients more likely to prescribe short acting bronchodilators, oxygen therapy, and consult pulmonology; higher rates of follow-up with pulmonary specialty within 30 days
**Rinne ST, et al.51	Impact of Multisystem Health Care on Readmission and Follow-up Among Veterans Hospitalized for Chronic Obstructive Pulmonary Disease	VA patients Medicare-eligible veterans n=4129	Retrospective cohort study	Use of no-VA outpatient care	30 day readmission: no association between non-VA care and any-cause readmission; increased COD-specific readmission risk with dual0-care and Medicare only.	N/A	30 day follow up: Medicare only outpatient care associated with lower rates of follow up
**Abusaada K, al.50	Comparison of hospital outcomes and resource use in acute COPD exacerbation patients managed by teaching versus nonteaching services in a community hospital	n=1419	Retrospective cohort study	Teaching vs. non-teaching services	30 day readmissions (NS)	Risk-adjusted cost (observed/expected) was lower in teaching vs. nonteaching group (0.66 vs. 1.06; p<0.001)	LOS lower in teaching group (p<0.001), mortality (NS); use of consults was lower in teaching group
**Agee J, et al..53	Reducing Chronic Obstructive Pulmonary Disease 30-Day Readmissions: A Nurse-Led Evidence-Based Quality Improvement Project	Adults, 18 years and older with a diagnosis of COPD at discharge	QI	Multidisciplinary team led by a chief nursing officer using the chronic care model with three teams: education, standardized pathway, and community teams	Goal of 10% reduction in COPD readmissions within 30 days of discharge from ED or hospitalizations; Results: 7.6% reduction in overall COPD admissions; 46% in COPD readmissions	N/A	Quality of life: St. George Respiratory Questionnaire: improved from 50.99 to 42.51 (delta of 8.48; delta of 8 units corresponds to ‘moderately efficacious”)
Bundled
**Parikh R, et al.54	COPD exacerbation care bundle improves standard of care, length of stay, and readmission rates.	Patients admitted with AECOPD n=44	Prospective, observational	COPD exacerbation bundle driven by guideline recommendations for AECOPD with multidisciplinary team: standard nursing protocols, patient education for inhaler technique, mediation options, order set, incorporated into their EHR.	30-day readmission rates (9.1% vs 54.4% in controls; P -value = 0.001), and 60-day readmission rates (22.7% vs 77% in controls; P-value = 0.0003) decreased in the care bundle group.	Ninety-day hospital costs had a significant difference in the care bundle group (US$7,652 vs US$19,954 in controls; P-value = 0.044).	LOS: 51.2 vs. 101.1 hours (p=0.001); 100% vs. 27.3% inhaler teaching (p<0.001), 59.1% vs. 18.2% pulmonologist follow-up post discharge (p=0.005), mean reduction in time to steroid administration (p=0.015)
**Zafar MA, et al.55	Reliable adherence to a COPD care bundle mitigates system-level failures and reduces COPD readmissions: a system redesign using improvement science.	Patients admitted with COPD	QI	Multidisciplinary team: COPD care bundle of five components-appropriate inhaler regimen; 30-day inhaler supply; personalized inhaler education; standardized discharge instructions/education; follow up within 15 days	Any unplanned readmission within 30 days of discharge after AECOPD admission based on number of bundle components received: overall declined from 22.7% to 14.7%; those with 4 or 5 bundle components were 12.5% and 10.9%; while those with two or more missed was 26.5% (p<0.05).	n/a	Process measures: adherence to COPD care bundle components and to each individual component(Goal 90%)-increased from 50% to 89%
**Bhatt SP, et al.56	Results of a Medicare Bundled Payments for Care Improvement Initiative for Chronic Obstructive Pulmonary Disease Readmissions	Medicare-only patients with AECOPD n=78	Pre/post	BPCI program: comprehensive COPD multi-disciplinary intervention focusing on inpatient, transitional, and outpatient care	All cause 30-day readmissions compared to historical controls: No differences (p=0.7); 90-day readmissions (p=0.2).	Costs after index hospitalization compared with BPCI target prices: No differences for hospital costs/savings; no difference in per-patient costs for index PBCI admission vs 2012 control subject admissions	BPCI patients were more like to receive vaccines (influenza and pneumococcal), be referred to pulmonary rehabilitation, have scheduled and attend follow-up appointments, and for active smokers to receive counselling (p<0.05)