The History of PRAXIS

COPD Hospital Readmissions

COPD-related exacerbations cause approximately 800,000 hospitalizations and 1.5 million emergency room visits annually. Another 3.5 million hospital stays include COPD as a secondary or complicating condition, illustrating the significant comorbidities associated with COPD. The Agency for Healthcare Quality and Research estimates that at any given time, 1 out of every 5 hospitalized individuals over the age of 40 has a diagnosis of COPD. These frequent exacerbations and hospitalizations result in worsening health status and decreased quality of life for patients and families.

The CMS Hospital Readmissions Reduction Program

In 2012, the Centers for Medicare & Medicaid Services (CMS) launched the Hospital Readmissions Reduction Program (HRRP) to reduce the risk of hospital readmissions in patients hospitalized for acute myocardial infarction, pneumonia or heart failure. In October of 2013, the CMS HRRP was expanded to include hospitalizations for COPD exacerbations. The CMS HRRP uses financial penalties to motivate hospitals to develop, test and implement quality improvement programs to reduce avoidable hospital readmissions within 30 days of hospital discharge. These financial penalties can be as high as 3% of hospital-specific Medicare payments for all discharges, not only payments related to the excess readmissions.

Reducing Avoidable COPD Readmissions — The Evidence

In October 2013, the COPD Foundation convened a multi-stakeholder National COPD Readmissions Summit to summarize our understanding of how to reduce hospital readmissions in patients hospitalized for COPD exacerbations and the potential implications for patient outcomes of adding COPD as a penalty-sensitive condition for the CMS HRRP. More than 225 individuals participated in the summit, either in person or via live video stream, including patients, clinicians, health service researchers, policy makers as well as representatives of academic health care centers, industry and payers.

Five main themes emerged from the summit, including; COPD cannot be ignored by health systems, communities and future research initiatives; initiatives to reduce readmissions must be focused beyond just 30 days to make a meaningful impact on patient outcomes; community and the patient voice must be recognized throughout these efforts; interventions will need to be tailored to the settings in which they implemented; and the system needs infrastructure to promote and sustain collaboration.

Summit experts developed a set of recommendations for those programs aimed at reducing hospital readmissions: 1) include specific recommendations about how to promote COPD self-management skills training for patients and their caregivers; 2) adequately address comorbidities common to COPD in care plans during and after hospitalizations; 3) include an evaluation of adverse events when implementing strategies to reduce hospital readmissions; and 4) develop a strategy (e.g., a learning collaborative) to connect groups who are engaged in developing, testing and implementing programs to reduce hospital readmissions for COPD and other conditions.

Out of this rich discussion, PRAXIS was born.