COPD Patient 30-Day Hospital Readmission Reduction Program

This white paper delineates a series of factors that can lead to COPD readmissions, including inadequate treatment of an initial exacerbation and lack of a clear and quick COPD action plan. The authors outline the elements of a patient-centered approach to readmissions reduction that improves COPD care across the continuum. Essential elements include: improvement of care transitions, implementation of two COPD care coordinator roles, follow-up care post-discharge that includes a home visit, adoption of a patient-centered care philosophy, the promotion of patient physical activity that includes pulmonary rehabilitation, effective patient education, appropriate equipment to treat and manage the disease, use of a rapid action plan and smoking cessation efforts that start during hospitalization. An overview of challenges encountered in COPD treatment and a more thorough discussion of factors leading to readmissions close the white paper.