1. UNC COPD Readmissions: Leveraging the Electronic Health Record to Identify At-Risk Patients
M. Bradley Drummond, MD MHS
Associate Professor, Pulmonary Medicine
Director, UNC Obstructive Lung Diseases Center

2. UNC COPD Readmissions Scope of the problem at UNC
Current UNC resources and situation assessment
Demonstration projects at UNC
Process to identity current care deficits at UNC
Electronic Health Record (EHR) -based pilot program
Identify at-risk COPD patients
Facilitate PCP notification

3. UNC Memorial/Hillsborough Hospital Discharges: Principal diagnosis COPD
Total=854
(71/mo)
Inpt=519
(43/mo)
ED=174
(15/mo)
Obs=161
(13/mo)
Diagnosis Codes: J41.1, 8; J42; J43.1,2,8,9; J44.X; J47.X; J68.4,8,9; Q33.4
Data courtesy Scott Keller (UNC)

4. UNC Memorial/Hillsborough Hospital Discharges: Principal diagnosis COPD by County
Rockingham
Caswell
Person
Granville 0% 1% 1% 1%
Guilford 2%
13%
19% 5%
Wake
Randolph 8%
Chatham 2% 6%
Pitt 2%
Harnett 2%
Rockingham-Caswell-Person-Granville
Guildford-Alamance-Orange-Durham
Randolph-Chatham-Wake
Harnett--Pitt
Cumberland-Sampson- Onslow
Cumberland
Sampson 3% 2%
Onslow 2%
Data courtesy Scott Keller (UNC)
N=496 inpatient admissions

5. UNC Memorial/Hillsborough Hospital Readmission Rate
Average 1-year readmission rate: 16.9%
Diagnosis Codes: J41.1, 8; J42; J43.1,2,8,9; J44.X; J47.X; J68.4,8,9; Q33.4
Data courtesy Scott Keller (UNC)

6. UNC COPD Discharges and Readmission: Medicare Data 7/1/13-6/30-16
UNC 30-day COPD readmission rate: 19%
Data courtesy John Vargas (UNC)
Source:

7. North Carolina COPD Readmission Ratio
CMS calculation: Excess readmissions are measured by a ratio, by dividing a hospital’s number of “predicted” 30-day readmissions by the number that would be “expected,” based on an average hospital with similar patients. A ratio greater than indicates excess readmissions.
Graph courtesy John Vargas (UNC)
Source:

8. Existing UNC Programs to Reduce Readmissions
Inpatient transitions team
Social worker
Case manager
Pharmacist
Primary care initiatives
Dr. Amy Shaheen
COPD Action Plan
System-wide education
COPD specialty clinic
Two COPD-focused MDs
COPD RN, Pharmacist, case manager
Curated COPD website
specialties/areas-and-programs/copd
COPD discharge clinic
Go-live pilot October 2018
7-14 day post-discharge follow-up
Aligning with Wake Forest and Duke programs

9. Action: Project Development- ED Discharges
Identified key deficits
Neglected population
ED/observation discharges
Lack of sufficient inhaler therapy
Lack of sufficient follow-up
Lack of pulmonary rehab referral
Collaborative project development
UNC Value Care Action Group
Pulmonary medicine
Internal medicine
EPIC staff

10. Pilot Intervention: EHR-driven COPD discharge identification
Automated daily EPIC list
Age >40
Seen in ED/observation unit and discharged in prior 24 hours
Medication order for nebulized albuterol
EPIC list screen
Conducted by Nancy Boughey, RN (Outpatient COPD RN)
Screen for possible COPD exacerbation
COPD diagnosis, smoking history, ED triage/discharge summaries
Probable COPD charts sent to COPD physician
Standardized EPIC letter to PCP inbox or fax
Track changes in medications, referrals, orders

12. Summary COPD readmissions reduction is multi-pronged approach
Inpatient, ED/Observation, Outpatient
Internal medicine, Pulmonary, Social work, Case management, Pharmacist
Key deficits still exist
Treatment, training, therapy
Nebulizer-based EHR algorithm can identify at-risk COPD patients and facilitate PCP notification
Continued efforts to optimize interventions to improve care