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Predicting and Preventing COPD Readmissions

Written by: Vester Gravley on Tuesday, July 15, 2014 Posted in:

If you are anything like me when you first heard that CMS was adding COPD to the list of conditions for readmission penalties you thought; “good luck with that!” If nothing else, COPD patients are well-known for an increasingly rapid cycle of admission and readmission due to exacerbation as their disease state progresses from bad to worse and from worse to end stage. Spiraling out of control, they eventually come into the hospital for the last time. For these patients the revolving door of readmission finally closes.

Given that the very pathology of the disease predisposes the patient to this costly pattern, the goal of reducing 30 day readmissions for this diagnostic group becomes a matter of widening the gap between patient stays by decreasing exacerbation events. While that may seem simple enough, translating it into sound, evidence-based, patient-focused, value-centered clinical practice is tricky business. This is especially true because, though the pathology shares certain characteristics, each COPD patient has their own unique clinical presentation. Along the spectrum of “blue bloater” to “pink puffer”, no two have exactly the same symptoms, triggers or working maintenance regimens; not to mention each one’s quirky psychological responses to the disease. Preventing acute exacerbations of COPD (AECOPD) leading to readmissions then becomes as much a therapeutic art as a clinical science and each therapist a Picasso or a Rembrandt. In the words of Khalil Gibran, “Art is a step from what is obvious and well-known toward what is arcane and concealed.” This step is our profession’s leap into the future.

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