COPD Exacerbations in Nursing Homes: A Retrospective Chart Review
Medicine and Health Sciences
Introduction: OPTIMISTIC is a project funded by the Centers for Medicaid and Medicare Services (CMS) that is aimed, in part, at the reduction of unnecessary hospitalization of nursing facility residents. Data from the initial phase of the project indicated that 11% of resident potentially avoidable hospitalizations were associated with a diagnosis of COPD. Avoidable hospital transfer of long-term stay nursing home residents carries both a large financial burden and a poor prognosis, making avoidance essential to care. Objective: This retrospective chart review has the goal of analyzing and describing the diagnosis, treatment strategies, and outcomes for nursing home patients treated for an exacerbation of COPD in OPTIMISTIC facilities. Methods: A list of all patients from OPTIMISTIC facilities that billed CMS for the diag-nosis of a COPD Exacerbation from 11/1/2017 to 6/1/2019 was obtained, the top 6 highest billing facilities were selected, and 3 patient charts from each facility were se-lected at random. This yielded 18 individual patient records, with 2 patients having multiple billing episodes within the time period, for a total of 23 episodes. A standard-ized data collection tool was used to collect information from both online electronic medical records and paper charts. The data tool included demographics, patient medical history, COPD staging and treatment, diagnostic data, treatment facts, and out-comes. All data was stored without patient identifiers, under password protection. Results: The mean age of patients was 82 years (n=18), and the percentage of patients suffering from an exacerbation and/or all cause hospitalization within one year of their certification were both 39% (n=7). 70% (n=16) of patients were certified by the provider within 2 days. In 78% (n=18) of cases, patients were able to recover to their prior condition within the facility, while only 9% (n=2) required the patient be transferred to the hospital. Providers ordered inhaled bronchodilators in 96% (n=22) of cases, antibiotics in 70% (n=16), and oral Prednisone in 78% (n=18) of cases. OPTIMISTIC certification criteria were met in 87% (n=20) of cases. Conclusions: Given the disease state, comorbidities, history, and age of this population, many are high-risk COPD patients. This chart review demonstrated efficacy of the OPTIMISTIC care model for in-house recovery of residents in an acute exacerbation of COPD. Patients were diagnosed and treated rapidly in a large majority of cases. Treatment strategies and choices aligned reasonably well with OPTIMISTIC evidence-based treatment protocols. Only one patient was not prescribed an inhaled bronchodilator, and most patients were given some course of oral prednisone, both of which are indicated in the treatment of an acute COPD exacerbation. Results indicated relatively low use of antibiotic therapy, but varied antibiotic usage of multiple classes, supporting the need for continued vigilance in antibiotic stewardship.
Copyright 2019 all authors
Elsener, Luke D. OMS-2; Mack, Laramie; and Unroe, Kathleen MD, MHA, "COPD Exacerbations in Nursing Homes: A Retrospective Chart Review" (2019). MU-COM Research Day. 150.