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Chest. 2016 Apr;149(4):905-15. doi: 10.1378/chest.15-0449. Epub 2016 Jan 12.

Association of Psychological Disorders With 30-Day Readmission Rates in Patients With COPD.

Author information

1
Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX. Electronic address: gpsingh@utmb.edu.
2
Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX.
3
Office of Biostatistics, University of Texas Medical Branch, Galveston, TX; Sealy Center of Aging, University of Texas Medical Branch, Galveston, TX.
4
Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX; Sealy Center of Aging, University of Texas Medical Branch, Galveston, TX.

Abstract

BACKGROUND:

There is a growing understanding of the prevalence and impact of psychological disorders on COPD. However, the role of these disorders in early readmission is unclear.

METHODS:

We analyzed data from 5% fee-for-service Medicare beneficiaries diagnosed with COPD (International Classification of Diseases, Ninth Revision code, 491.xx, 492.xx, 493.xx, and 496.xx) between 2001 and 2011 who were hospitalized with a primary discharge diagnosis of COPD or a primary discharge diagnosis of respiratory failure (518.xx and 799.1) with secondary diagnosis of COPD. We hypothesized that such psychological disorders as depression, anxiety, psychosis, alcohol abuse, and drug abuse are independently associated with an increased risk of 30-day readmission in patients hospitalized for COPD.

RESULTS:

Between 2001 and 2011, 135,498 hospitalizations occurred for COPD in 80,088 fee-for-service Medicare beneficiaries. Of these, 30,218 (22.30%) patients had one or more psychological disorders. In multivariate analyses, odds of 30-day readmission were higher in patients with COPD who had depression (OR, 1.34; 95% CI, 1.29-1.39), anxiety (OR, 1.43; 95% CI, 1.37-1.50), psychosis (OR, 1.18; 95% CI, 1.10-1.27), alcohol abuse (OR, 1.30; 95% CI, 1.15-1.47), and drug abuse (OR, 1.29; 95% CI, 1.11-1.50) compared with those who did not have these disorders. These psychological disorders increased amount of variation in 30-day readmission attributed to patient characteristics by 37%.

CONCLUSIONS:

Psychological disorders like depression, anxiety, psychosis, alcohol abuse, and drug abuse are independently associated with higher all-cause 30-day readmission rates for Medicare beneficiaries with COPD.

KEYWORDS:

COPD; anxiety; depression; medicare; readmission

PMID:
26204260
PMCID:
PMC4944783
DOI:
10.1378/chest.15-0449
[Indexed for MEDLINE]
Free PMC Article
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