M. Bradley Drummond, MD MHS Associate Professor, Pulmonary Medicine

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Presentation transcript:

UNC COPD Readmissions: Leveraging the Electronic Health Record to Identify At-Risk Patients M. Bradley Drummond, MD MHS Associate Professor, Pulmonary Medicine Director, UNC Obstructive Lung Diseases Center brad_drummond@med.unc.edu

UNC COPD Readmissions Scope of the problem at UNC Current UNC resources and situation assessment Demonstration projects at UNC Process to identity current care deficits at UNC Electronic Health Record (EHR) -based pilot program Identify at-risk COPD patients Facilitate PCP notification

UNC Memorial/Hillsborough Hospital Discharges: Principal diagnosis COPD Total=854 (71/mo) Inpt=519 (43/mo) ED=174 (15/mo) Obs=161 (13/mo) Diagnosis Codes: J41.1, 8; J42; J43.1,2,8,9; J44.X; J47.X; J68.4,8,9; Q33.4 Data courtesy Scott Keller (UNC)

UNC Memorial/Hillsborough Hospital Discharges: Principal diagnosis COPD by County Rockingham Caswell Person Granville 0% 1% 1% 1% Guilford 2% 13% 19% 5% Wake Randolph 8% Chatham 2% 6% Pitt 2% Harnett 2% Rockingham-Caswell-Person-Granville Guildford-Alamance-Orange-Durham Randolph-Chatham-Wake Harnett--Pitt Cumberland-Sampson- Onslow Cumberland Sampson 3% 2% Onslow 2% Data courtesy Scott Keller (UNC) N=496 inpatient admissions

UNC Memorial/Hillsborough Hospital Readmission Rate Average 1-year readmission rate: 16.9% Diagnosis Codes: J41.1, 8; J42; J43.1,2,8,9; J44.X; J47.X; J68.4,8,9; Q33.4 Data courtesy Scott Keller (UNC)

UNC COPD Discharges and Readmission: Medicare Data 7/1/13-6/30-16 UNC 30-day COPD readmission rate: 19% Data courtesy John Vargas (UNC) Source: https://data.medicare.gov/Hospital-Compare/Hospital-Readmission-Rates/92ps-fthr/data#revert

North Carolina COPD Readmission Ratio CMS calculation: Excess readmissions are measured by a ratio, by dividing a hospital’s number of “predicted” 30-day readmissions by the number that would be “expected,” based on an average hospital with similar patients. A ratio greater than 1.0000 indicates excess readmissions. Graph courtesy John Vargas (UNC) Source: https://data.medicare.gov/Hospital-Compare/Hospital-Readmission-Rates/92ps-fthr/data#revert

Existing UNC Programs to Reduce Readmissions Inpatient transitions team Social worker Case manager Pharmacist Primary care initiatives Dr. Amy Shaheen COPD Action Plan System-wide education COPD specialty clinic Two COPD-focused MDs COPD RN, Pharmacist, case manager Curated COPD website https://www.med.unc.edu/pulmonary/ specialties/areas-and-programs/copd COPD discharge clinic Go-live pilot October 2018 7-14 day post-discharge follow-up Aligning with Wake Forest and Duke programs

Action: Project Development- ED Discharges Identified key deficits Neglected population ED/observation discharges Lack of sufficient inhaler therapy Lack of sufficient follow-up Lack of pulmonary rehab referral Collaborative project development UNC Value Care Action Group Pulmonary medicine Internal medicine EPIC staff

Pilot Intervention: EHR-driven COPD discharge identification Automated daily EPIC list Age >40 Seen in ED/observation unit and discharged in prior 24 hours Medication order for nebulized albuterol EPIC list screen Conducted by Nancy Boughey, RN (Outpatient COPD RN) Screen for possible COPD exacerbation COPD diagnosis, smoking history, ED triage/discharge summaries Probable COPD charts sent to COPD physician Standardized EPIC letter to PCP inbox or fax Track changes in medications, referrals, orders

Summary COPD readmissions reduction is multi-pronged approach Inpatient, ED/Observation, Outpatient Internal medicine, Pulmonary, Social work, Case management, Pharmacist Key deficits still exist Treatment, training, therapy Nebulizer-based EHR algorithm can identify at-risk COPD patients and facilitate PCP notification Continued efforts to optimize interventions to improve care