Mortal Combat: Defining the Win in the Battle Against COPD
My most recent post plugged the release of the National COPD Action Plan at the ATS 2017 International Conference held in Washington DC. Also coming out of the ATS conference is the presentation of new research finding that for COPD “in-hospital deaths decreased substantially during between 2005 and 2014”. Per rtmagazine.com“The researchers analyzed data from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample, which captures 95% of all hospital discharges in the US. They found that there were 8,575,820 hospitalizations for COPD-related health problems between 2005-2014. During that time, those who died in the hospital declined from 24,226 to 9,090—a 62% decrease.” Wow! That’s awesome! But it is only part the picture.
In February 2017 COPD News Today published an article entitled “Each Year 10,000 Healthy Patients, Many with COPD, Die Within a Week of Leaving the ER”. Over a 5-year timeframe that falls in the middle that of the study mentioned above, researchers noted that; “Each year, more than 10,000 generally healthy patients die within seven days after being discharged from a hospital emergency room…”. And that, “Heart disease and chronic obstructive pulmonary disease (COPD) are the most common causes of death among these patients.” Looking at 16 million emergency room visits between 2007 to 2012, Obermeyer et al found “that each year, 10,093 patients died within seven days after being sent home. The mean age at time of death was 69.” Of that 10,093 deaths, 9.6 % listed the leading causes of death as COPD. That translates to just shy of 1000 deaths per year secondary to COPD, post discharge from the ER. When considered this data changes the overall mortality math by roughly 5000 deaths over the same period. These were patients not admitted to hospital and thus not included in the 62% reduction in inpatient mortality. Other critical questions arise:
- Is a penalty driven emphasis on decreasing readmissions adversely influencing ER discharges for COPD and other patients?
- What follow up processes may be required for patients with COPD discharged from the ER to home?
- What “other” factors in the home may be contributory to increased mortality for COPD patients and what potential interventions can be applied to prevent early mortality?
Goal 2 of the National COPD Action Plan is to “Improve the diagnosis, prevention, treatment, and management of COPD by improving the quality of care delivered across the health care continuum.” I propose that decreasing mortality post discharge from the ER to home for people with COPD may be a top box indicator of success. In the fight to improve the lives of people with COPD let’s fight to win!