High rates of hospital readmissions and unexplained variation in those rates may indicate problems in transitions of care and outpatient management following discharge. While some readmissions may be unavoidable, reducing hospital readmissions has been an objective of the Affordable Care Act and accountable care organizations. Improving the quality of care including care transitions at the time of hospital discharge may result in fewer hospital readmissions and associated costs. Examining characteristics that explain variability in readmission rates can help to identify opportunities for targeted interventions for patients with common high risk conditions such as chronic obstructive pulmonary disease (COPD).,,