Modeling and Analysis of Postdischarge Intervention Process to Reduce COPD Readmissions

This paper is devoted to modeling and analysis of intervention process to reduce hospital readmissions of patients with chronic obstructive pulmonary disease (COPD). As compliance is a major issue among COPD patients, and economic burden and social support can be important factors affecting compliance and readmission, we propose to hospital management to reimburse out-of-pocket and transportation costs for COPD patients visiting primary care physicians and rehab centers, which are used as incentives to encourage them complying with patient-specific intervention plan. Then, we introduce an optimization model to minimize COPD readmission rate under incentive budget constraint and patients’ readmission risks. Solving the problem, the minimal readmission rates are evaluated and the conditions to achieve the optimal solution are derived, which can provide a guideline for hospital management to plan appropriate incentive budget and benchmark the desired readmission rate. A case study at a community hospital is presented to illustrate the method. Finally, cost-effective analysis, sensitivity studies, and implementation discussions are carried out. Note to Practitioners —Chronic obstructive pulmonary disease (COPD) is one of the leading causes of death in U.S. and worldwide. Since 2014, hospitals with excessive unplanned readmissions within 30 days for COPD patients are penalized by the Centers for Medicare and Medicaid Services. Thus, substantial efforts have been devoted to reducing COPD patients’ readmissions. To achieve a low readmission rate, effective and patient-specific interventions in postdischarge care are needed. It has been discovered that a low medical compliance level is one of the major obstacles and challenges impeding such efforts, which can be due to psychosocial issues, such as low socioeconomic status, economic burden, lack of social support, and so on. To improve medical compliance and reduce readmissions, this paper investigates the intervention process and introduces an incentive-based framework to encourage COPD patients following the desired intervention plan for readmission reduction. Optimal solutions under different incentive budget levels are derived, which can provide hospital management a benchmark and guidance to design appropriate incentive policies to minimize readmission. Sensitivity and cost-effective analyses are carried out, and a case study at St. Mary’s Hospital is presented to illustrate the applicability of the model and the analysis. Such a model provides a quantitative tool for hospital management to help design patient-centered intervention plan to reduce COPD readmission.