Quality of Care Delivered to Veterans with COPD Exacerbation and the Association with 30-Day Readmission and Death

Abstract

Quality of chronic obstructive pulmonary disease (COPD) care is thought to be an important intermediate process to improve the well-being of patients admitted to hospital for exacerbation. We sought to examine the quality of inpatient COPD care and the associations with readmission and mortality. We performed a cohort study of 2,364 veterans aged over 40 and hospitalized for COPD between 2005 and 2011 at five Department of Veterans Affairs hospitals. We examined whether patients received six guideline recommended care items including short-acting bronchodilators, corticosteroids, antibiotics, positive-pressure ventilation (in cases of acute hypercarbic respiratory failure), chest imaging, and arterial blood gas measurement. Our primary outcome was all-cause hospital readmission or death within 30 days. Overall quality of care was not significantly associated with readmission or death (acute care aOR 0.98; 95% CI 0.87–1.11; ICU aOR 0.89; 95% CI 0.71–1.13). Delivery of corticosteroids and antibiotics was associated with reduced odds of readmission and death (aOR 0.77; 95% CI 0.61–0.92). Few patients received all of the recommended care items (18% of acute care, 38% of ICU patients). Quality of care did not vary by race or sex but did vary significantly across sites and did not improve over time. Our composite measure of COPD care quality was not associated with readmission or death. Further efforts are needed to improve care delivery to patients hospitalized with COPD.

Keywords:

• Chronic obstructive pulmonary disease (COPD)
• quality
• outcomes
• readmission

Disclosure statement

D.H.A reports personal fees from Novartis for service on a data monitoring committee, personal fees from American Board of Internal Medicine for service on the exam writing committee, and personal fees from Annals of the American Thoracic Society for service as a deputy editor, outside the submitted work. L.J.S. reports grant support from NIH NHLBI T32HL007287-38 and F32HL142125-01, during the conduct of the study. L.M.D. reports grant support from NIH NHLBI T32HL007287-38, during the conduct of the study. M.F.G. reports grant support from NIH NHLBI T32HL007287-38, during the conduct of the study. L.C.F reports grants from NIH K23 HL111116, grants from American Lung Association, grants from Veteran's Health Administration, outside the submitted work.

Additional information

Funding

LJS reports grant support from NIH NHLBI F32HL142125-01 and 5K12HL137940-02. Study staff also supported by VA Puget Sound Health Services Research & Development. Partial support for the development of this dataset was provided by Gilead Sciences with research funding to the Seattle Institute for Biomedical and Clinical Research. The views expressed here are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs. None of the funding sources were involved in the design, conduct or analysis of this project.