Retrospective, matched cohort study of the effectiveness of common COPD drug treatments on 30-day readmissions

Abstract

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is a prevalent lung disease that represents an important public health challenge. Pharmacological treatment of COPD continues to be a challenge in the US, especially in rural areas. Hospitals with high 30-day readmissions may face penalties under HRRP.

Research Question: Are common pharmacological treatments effective in controlling early hospital readmission?

Methods: In this study, we conducted a phase IV drug trial of combination treatments: budesonide/formoterol and fluticasone/salmeterol. We utilized Cerner health facts database to compare 30-day readmission rates among patients prescribed these COPD treatments. Using propensity score matching and chi-square analysis on patient demographics and hospital-associated variables, we tested for differences in readmission rates. Covariates used: drug type, race, marital status, payer type, gender, and hospital location.

Results: Overall there were no significant differences in 30 day readmission rates between treatments. However, the combination of budesonide/formoterol was found to have a lower readmission rate than fluticasone/salmeterol in COPD patients in urban hospital settings, self-payers, Medicare/Medicaid patients, and Caucasians.

Conclusions: Identifying treatments that have lower 30-day readmission among patients could influence clinical decisions as providers make choices regarding patient care such as hospital length of stay and discharge options. However, due to the observational nature we cannot conclude with certainty that medication was the only factor responsible for any differences observed in this study. Further studies are needed which could provide information to guide further research for therapeutics and tools to better patient management post discharge.