Readmission reduction by dedicating a pulmonary case manager in Veterans with COPD at the Orlando VA Medical Center

From the 2019 HVPAA National Conference

Ms. Michelle Thayer (Orlando VA Medical Center), Dr. Ahmed Alsaei (University of Central Florida), Ms. Dipika Patel (Orlando VA Medical Center), Dr. Kulsum Casey (Orlando VA Medical Center), Dr. Joseph Gutmann (Orlando VA Medical Center), Dr. Natarajan Rajagopalan (Orlando VA Medical Center)

Background

Chronic Obstructive Pulmonary Disease (COPD) is the third leading cause of death in the United States. Veterans are at greater risk of COPD, due to chemical exposures and combat experience being associated with high-risk behaviors such as smoking. Every year approximately 500,000 Veterans receiving care through the Department of Veterans Health Administration (VHA) are diagnosed with COPD. COPD is a frequent discharge diagnosis at VHA medical centers. One out of five patients hospitalized for COPD exacerbation will be re-hospitalized within a 30-day period. Patients readmitted for COPD within 30-days of discharge have an increased risk of death over a 3-year period and poses high costs to the health-care system. At the Orlando Veteran Affairs Medical Center (OVAMC), the readmission rate is 31.38% compared to VA National Average of 24.31%. We conducted this project to reduce the readmission rates for COPD patients at the OVAMC with a primary diagnosis of acute COPD exacerbation.

Methods

In May 2018, a pulmonary case manager position was created to ensure admission and discharge diagnoses are documented accurately, appropriate diagnostic tests are ordered, and pulmonary consults are requested for those at high risk for readmission. COPD education was implemented before discharge, follow ups phone calls were made weekly for 30 days, and patients were seen in clinic within 10 days of patients discharges. In patients with transportation challenges, video conferences were made with a multidisciplinary team consisting of a pulmonologist, ARNP, Case Manager, and a Respiratory Therapist. A 6-month period data were analyzed before and after the above interventions.

Results

Within the first year, the OVAMC COPD readmission rate was reduced 6.13% from 31.38% to 25.25%. During this project, 84 patients were admitted with COPD diagnosis. 15 patients did not meet COPD diagnosis requirements, 4 discharge diagnoses were corrected. Inaccurate coding accounted for 13% of patients’ readmission rates was discounted when calculating the rate.

Conclusion

Implementation of the above interventions in patients admitted with Acute COPD exacerbations reduced 30-day hospital readmission rates, from 31.38% to 25.25% in our OVAMC patient population.