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Transitional Care Management for COPD: The University of Michigan Experience
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A2765 - Transitional Care Management for COPD: The University of Michigan Experience
Author Block: J. Taylor1, C. Martinez2, M. Sjoding2, W. W. Labaki2, A. Kurili2, M. K. Han2, C. A. Meldrum2; 1Internal Medicine and Pediatrics, University of Michigan, Ann Arbor, MI, United States, 2Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, United States.
Background: COPD exacerbations requiring hospitalization are a major source of morbidity and mortality with 1-month readmission rates of approximately 20%. Hence reducing COPD readmissions has been a major focus for insurers, and particularly CMS, with increasing emphasis on improving transitions of care for patients hospitalized for COPD exacerbations. We report on a single center COPD Transitional Care Management (TCM) Clinic experience.
Methods: The University of Michigan Health System established a COPD TCM Clinic in 2016. Patients referred to this clinic by inpatient providers would ideally be seen within 7-14 days of discharge. The clinic was comprised of an expert COPD clinician physician, respiratory therapy, dedicated nurse coordinator, social work, dietary, and a tobacco cessation specialist. Patients received a comprehensive evaluation including symptom questionnaires and pulmonary function testing. We analyzed data on clinic patients evaluated in the first 18 months of operation.
Results: Of 460 patients admitted for a COPD exacerbation during this time period, only 36 were seen in TCM clinic. Challenges to evaluating patients included lack of referral, competing medical appointments and inadequate transportation. Mean age for the group was 67 years, mean FEV1% predicted 52%. Of 36 patients seen, 30(83%) actually had confirmed diagnosis of COPD. Alternative diagnoses were asthma (n=3), mild obstructive tobacco related lung disease (n=1), cirrhosis (n=1), and diaphragmatic paralysis (n=1). The overall readmission rate for the 460 patients admitted to UMHS for COPD exacerbations during this time period was 17%. The readmission rate for patients seen in the TCM clinic was 75%. For those TCM patients readmitted, the reasons for readmission were COPD exacerbation (n=12, 44%), cardiac causes (n=4,14%), pneumonia (n=4, 14%) and other causes (n=7, 21%). Over an 18- month period, the all-cause mortality rate for patients seen in the TCM clinic was 20%. For those not seen, the mortality rate was 6%.
Conclusions: Funneling patients hospitalized for a COPD exacerbation into a TCM clinic is challenging. Patients evaluated by the TCM clinic were significantly sicker as evidenced by the very high readmission and mortality rates as compared to those not evaluated. Among this sick TCM patient population, however, 17% of the evaluated patients did not have confirmed COPD and a significant percentage of readmissions were for non-COPD causes. This analysis demonstrates the difficulties in accurate diagnosis as well as effective outpatient management of
COPD, while at the same time illustrating how important comorbid conditions are in assessing a composite readmission risk.
Author Block: J. Taylor1, C. Martinez2, M. Sjoding2, W. W. Labaki2, A. Kurili2, M. K. Han2, C. A. Meldrum2; 1Internal Medicine and Pediatrics, University of Michigan, Ann Arbor, MI, United States, 2Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, United States.
Background: COPD exacerbations requiring hospitalization are a major source of morbidity and mortality with 1-month readmission rates of approximately 20%. Hence reducing COPD readmissions has been a major focus for insurers, and particularly CMS, with increasing emphasis on improving transitions of care for patients hospitalized for COPD exacerbations. We report on a single center COPD Transitional Care Management (TCM) Clinic experience.
Methods: The University of Michigan Health System established a COPD TCM Clinic in 2016. Patients referred to this clinic by inpatient providers would ideally be seen within 7-14 days of discharge. The clinic was comprised of an expert COPD clinician physician, respiratory therapy, dedicated nurse coordinator, social work, dietary, and a tobacco cessation specialist. Patients received a comprehensive evaluation including symptom questionnaires and pulmonary function testing. We analyzed data on clinic patients evaluated in the first 18 months of operation.
Results: Of 460 patients admitted for a COPD exacerbation during this time period, only 36 were seen in TCM clinic. Challenges to evaluating patients included lack of referral, competing medical appointments and inadequate transportation. Mean age for the group was 67 years, mean FEV1% predicted 52%. Of 36 patients seen, 30(83%) actually had confirmed diagnosis of COPD. Alternative diagnoses were asthma (n=3), mild obstructive tobacco related lung disease (n=1), cirrhosis (n=1), and diaphragmatic paralysis (n=1). The overall readmission rate for the 460 patients admitted to UMHS for COPD exacerbations during this time period was 17%. The readmission rate for patients seen in the TCM clinic was 75%. For those TCM patients readmitted, the reasons for readmission were COPD exacerbation (n=12, 44%), cardiac causes (n=4,14%), pneumonia (n=4, 14%) and other causes (n=7, 21%). Over an 18- month period, the all-cause mortality rate for patients seen in the TCM clinic was 20%. For those not seen, the mortality rate was 6%.
Conclusions: Funneling patients hospitalized for a COPD exacerbation into a TCM clinic is challenging. Patients evaluated by the TCM clinic were significantly sicker as evidenced by the very high readmission and mortality rates as compared to those not evaluated. Among this sick TCM patient population, however, 17% of the evaluated patients did not have confirmed COPD and a significant percentage of readmissions were for non-COPD causes. This analysis demonstrates the difficulties in accurate diagnosis as well as effective outpatient management of
COPD, while at the same time illustrating how important comorbid conditions are in assessing a composite readmission risk.
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