Methadone-maintained patients in primary care have higher rates of chronic disease and multimorbidity,and use health services more intensively than matched controls

Background: Methadone maintenance treatment in primary care is cost-effective and improves outcomes for opiate-dependent patients. A more developed understanding of the evolving needs of this important cohort will facilitate further improvements in their integrated care within the community.

Objectives: The aim of this study was to compare the burden of chronic disease, multi-morbidity and intensity of health-service use between methadone-maintained patients (MMPs) and matched controls in primary care.

Methods: This is a retrospective matched case-control design. Data on chronic disease and health service use was collected in 13 computerized GP surgeries on 414 patients (207 MMPs and 207 controls). Twelve months of records were examined. MMPs were compared with controls matched by gender, age, socio-economic status (SES) and GP surgery.

Results: MMPs suffered more chronic disease (OR = 9.1, 95% CI: 5.4–15.1, P < 0.001) and multi-morbidity (OR = 6.6, 95% CI: 4.3–10.2, P < 0.001). They had higher rates of respiratory, psychiatric and infectious disease. MMPs of lower SES had more chronic disease than their peers (OR = 7.2, 95% CI: 2.4–22.0, P < 0.001). MMPs attended the doctor more often with medical problems (OR = 15.4, 95% CI: 8.2–28.7, P < 0.001), with a frequent requirement to have medical issues addressed during methadone-management visits. Their care generated more telephone calls (OR = 4.4, 95% CI: 2.8–6.8, P < 0.001), investigations (OR = 1.8, 95% CI: 1.2–2.7, P = 0.003), referrals (2.6, 95% CI: 1.7–4.0, P < 0.001), emergency department visits (2.1, 95% CI: 1.3–3.6, P = 0.004), outpatient attendances (2.3, 95% CI: 1.51–1.43, P < 0.001) and hospital admissions (3.6, 95% CI: 1.6–8.1, P = 0.001).

Conclusion: Correcting for routine methadone care and drug-related illnesses, MMPs had a higher burden of chronic disease and used both primary and secondary health services more intensively than matched controls.     

Why some children hospitalized for pneumonia do not consult with a general practitioner before the day of hospitalization

Abstract

Background: Early consultation in primary care may provide an opportunity for early intervention in children developing pneumonia, but little is known about why some children do not consult a general practitioner (GP) before hospitalization.

Objectives: To identify differences between children who consulted a GP and children who did not consult a GP before the day of hospital presentation with pneumonia or empyema.

Methods: Carers of children aged six months to 16 years presenting to hospital with pneumonia or empyema completed a questionnaire, with a subset participating in an interview to identify physical, organizational and psychological barriers to consultation. Responses from those who had consulted a GP before the day of hospital presentation were compared with those who had not on a range of medical, social and environmental variables.

Results: Fifty seven (38%) of 151 participants had not consulted a GP before the day of hospital presentation. On multivariate analysis, illness duration ≥ 3 days (odds ratio [OR] 4.36, 95% confidence interval [CI]: 1.67–11.39), prior antibiotic use (OR: 10.35, 95% CI: 2.16–49.55) and home ownership (OR: 3.17, 95% CI: 1.07–9.37) were significantly associated with early GP consultation (P < 0.05). Interviews with 28 carers whose children had not seen a GP before the day of presentation revealed that most had not considered it and/or did not think their child's initial symptoms were serious or unusual; 11 (39.3%) had considered consulting a GP but reported barriers to access.

Conclusion: Lack of early GP consultation was strongly associated with rapid evolution of pneumonia.     

Factors associated with professional satisfaction in primary care: Results from EUprimecare project

Background: Given the importance of primary care to healthcare systems and population health, it seems crucial to identify factors that contribute to the quality of primary care. Professional satisfaction has been linked with quality of primary care. Physician dissatisfaction is considered a risk factor for burnout and leaving medicine.

Objectives: This study explored factors associated with professional satisfaction in seven European countries.

Methods: A survey was conducted among primary care physicians. Estonia, Finland, Germany and Hungary used a web-based survey, Italy and Lithuania a telephone survey, and Spain face to face interviews. Sociodemographic information (age, sex), professional experience and qualifications (years since graduation, years of experience in general practice), organizational variables related to primary care systems and satisfaction were included in the final version of the questionnaire. A logistic regression analysis was performed to assess the factors associated with satisfaction among physicians.

Results: A total of 1331 primary care physicians working in primary care services responded to the survey. More than half of the participants were satisfied with their work in primary care services (68.6%). We found significant associations between satisfaction and years of experience (OR?=?1.01), integrated network of primary care centres (OR?=?2.8), patients having direct access to specialists (OR?=?1.3) and professionals having access to data on patient satisfaction (OR?=?1.3). Public practice, rather than private practice, was associated with lower primary care professional satisfaction (OR?=?0.8).

Conclusion: Elements related to the structure of primary care are associated with professional satisfaction. At the individual level, years of experience seems to be associated with higher professional satisfaction.     

Primary health care for Aboriginal women and children in the year after birth: findings from a population‐based study in South Australia

Objective: To investigate the extent to which Aboriginal women access primary care for themselves and their infant in the year after childbirth. Method: Cross sectional population‐based survey of women giving birth to Aboriginal babies in South Australia between July 2011 and June 2013. Results: A total of 344 women took part in the study 4–9 months after giving birth. The majority had seen a primary health care practitioner since the birth: 86% had seen a Child and Family Health Service (CaFHS) nurse, 81% a general practitioner (GP), and 61% an Aboriginal health worker (AHW). Women living in remote areas were more likely to have seen primary care practitioners than women living in Adelaide (GP: OR 2.3, 95% CI 1.0–5.2; CaFHS: OR 2.4, 95% CI 1.0–5.8; AHW: OR 5.2, 95% CI 2.8–9.8). Around 16% of women with gestational diabetes and 10% with hypertension had not seen a GP since the birth, and 24% of women who had a low birthweight infant had not seen a CaFHS nurse. Conclusions: Despite high prevalence of maternal and infant morbidity, a sizeable minority of women did not access primary care practitioners postpartum. Implications for public health: Stronger efforts are needed to ensure Aboriginal women and families receive appropriate postnatal follow‐up.     

Health care service use among vulnerable adolescents

Abstract

This article describes the patterns of health care service use among a cohort of vulnerable adolescents with a history of homelessness and uses the Expanded Behavioral Model for Vulnerable Populations to examine factors associated with use of ambulatory and emergent care. We incorporated a health care interview into an existing longitudinal study of newly homeless adolescents, at their 24-month assessment (n?=?183) and assessed their sociodemographic characteristics, including living situation, health insurance rates, having a regular source of care, substance use and health care service use in the past 3 months. By the 24-month assessment, 63% of youth had returned home and 37% were currently homeless. In comparing youth who were currently homeless and those who had returned home, we found similar rates for ambulatory care use (48%) and for emergent care use (15%). The most common reason for seeking ambulatory care related to sexually transmitted disease (STD) testing/HIV testing/reproductive health for both groups. However, currently homeless youth were more likely to seek emergent care for trauma (15% vs. 4%, p?<?0.01) and for common conditions such as skin problems/respiratory infections/gastrointestinal problems/other problems (16% vs. 7%, p?<?0.05). Using multivariate logistic regression, we found older age [odds ratio (OR) 2.6, 95% confidence interval (CI) 1.0–6.5] and health insurance (OR 2.3, 95% CI 1.1–4.5) to be associated with use of ambulatory care; however, only older age (OR 2.7, 95% CI 1.0–7.0) was found to be associated with use of emergent care. Housing status, emotional distress and substance use were not found to be associated with ambulatory or emergent care use. Our findings suggest that facilitating health insurance coverage for vulnerable adolescents with a history of homelessness may lead to increased use of ambulatory care services and may consequently prevent use of emergent care services for conditions that may be treated in the ambulatory care setting.     

Factors affecting patient access in Thailand: Understanding delay in care seeking for patients with cancer

Abstract

While nearly three-quarters of cancer mortalities occur in low- and middle-income countries, we know little about the factors contributing to patient delays in seeking care for cancer. Our study employs a multifactorial approach by examining three key areas: patient socio-demographic factors, structural factors of health-care access and cancer patients' beliefs about their illness and cancer in general as potential determinants of their delay in seeking care in Thailand.

We conducted a cross-sectional study using a systematic sample of 264 patients with cancer treated during 2006–2007 at Prince Maha Vajiralongkorn Cancer Centre, a hospital of the National Cancer Institute of Thailand. We defined patient delay as when a patient waited more than 3 months after symptom onset to seek medical care. We used bivariate analysis and multivariate logistic regression to examine unadjusted and adjusted associations of patient delays in seeking care with: patient socio-demographic factors, structural factors of health-care access and patients' beliefs about their illness in particular and about cancer in general. We also obtained patient self-reports about their reasons for delaying care.

In multivariate analysis, only patient-belief factors were significantly associated with delay. Patients who believed that the primary causes of cancer were non-medical (vs. medical) were more likely to delay seeking care (adjusted odds ratio (OR)=4.37, 95% confidence interval (CI)=2.27–8.67). Patients who believed that cancer was probably curable or was curable (vs. incurable) were significantly less likely to delay seeking care (adjusted OR=0.2, 95% CI=0.08–0.56; adjusted OR=0.18, 95% CI=0.07–0.49, respectively). Patient socio-demographic factors and structural factors of health-care access were not significantly associated (p>0.05).

Our findings suggest that interventions to reduce delays in care seeking should address patient beliefs regarding cancer in order to effectively mitigate barriers to access.     

Quantitative comparison of measurements of urgent care service quality

ABSTRACT

Service quality and patient satisfaction are essential to health care organization success. Parasuraman, Zeithaml, and Berry introduced SERVQUAL, a prominent service quality measure not yet applied to urgent care. We develop an instrument to measure perceived service quality and identify the determinants of patient satisfaction/ behavioral intentions. We examine the relationships among perceived service quality, patient satisfaction and behavioral intentions, and demonstrate that urgent care service quality is not equivalent using measures of perceptions only, differences of expectations minus perceptions, ratio of perceptions to expectations, and the log of the ratio. Perceptions provide the best measure of urgent care service quality.     

Association between perceived health status and satisfaction with quality of care: evidence from users of primary health care in Oman

OBJECTIVE: Our aim was to assess the influence of perceived health status, as measured by SF-12, on the client's views of service quality. METHODS: A structured interview of patients was carried out in six primary health care centres in Adh Dhahira region health authority in the Sultanate of Oman. A total of 1226 patients aged 15 and over attending the different health care services within the health centres took part in the study. The main outcome measures were patients' satisfaction with the different aspects of health care and their perceived physical and mental health status. RESULTS: When adjusted for the relevant background factors such as age and gender, poor perceived health status has been found to predict less positive judgements of various aspects of health care quality. Poor mental health status, for example, predicts less positive judgements of aspects that are linked to the accessibility of the service and interpersonal aspects of care such as the working hours of the centre, GP's attitude and time spent with the GP (P < 0.05, <0.05 and <0.01, respectively). Poor physical health status, on the other hand, predicts less positive judgements of aspects such as cleanliness of the building, confidentiality of consultation with the GP, explanation about the visit to the antenatal clinic and standard of antenatal clinic in general (P < 0.05, <0.05, <0.05 and <0.05, respectively). CONCLUSION: Users' perceived health status has to be evaluated concurrently with assessing satisfaction with the quality of health care services. This would provide more valid results with regard to the patients' views on their level of satisfaction with health care quality.     

Contraceptive care in the VA health care system

BackgroundLittle is known about contraceptive care within the Veterans Affairs (VA) health care system. This study was conducted to assess the prevalence of documented contraception by race/ethnicity within the VA and to examine the association between receiving primary care in women's health clinics (WHCs) and having a documented contraceptive method.Study DesignWe examined national VA administrative and pharmacy data for 103,950 female veterans aged 18–45 years who made at least one primary care clinic visit in 2008. Multivariable regression models were used to examine the associations between race/ethnicity and receipt of care in a WHC with having a method of contraception while controlling for confounders.ResultsOnly 22% of women veterans had a documented method of contraception during 2008. After adjusting for potential confounders, Hispanic and African–American women were significantly less likely to have a method compared to whites [odds ratio (OR): 0.82; 95% confidence interval (CI): 0.76–0.88 and OR: 0.85; 95% CI: 0.81–0.89, respectively]. Women who went to WHCs were significantly more likely to have a method of contraception compared to women who went to traditional primary care clinics (OR: 2.05; 95% CI: 1.97–2.14).ConclusionsOverall contraceptive prevalence in the VA is low, but receiving care in a WHC is associated with a significantly higher likelihood of having a contraceptive method.     

Physical activity promotion in primary health care: Results from a German physician survey

Abstract

Background: Primary care physicians are positioned to play an important role in changing physical activity and other health behaviour of their patients. However, little is known about the practice of physical activity promotion in German primary care settings and the factors associated with physical activity promotion. Methods: 260 randomly selected physicians from the State Medical Association of Baden-Wuerttemberg, Germany, took part in this survey (response rate: 13.3%) and provided data on physical activity promotion (physical activity assessment and advice), attitudes towards health promotion and cooperation activities. Factors associated with physical activity promotion were identified using logistic regression. Results: The physicians who replied had positive attitudes towards health promotion. However, 26.9% reported they had inadequate knowledge to provide counselling and 36.7% felt they were unsuccessful in motivating their patients to increase physical activity. Physical activity assessment and advice occurred in 54.9% of the physicians. Compared to their counterparts, physicians in large cities (odds ratio (OR) 3.93; and 95% confidence interval (95%CI): 1.55–9.99), those convinced to offer their patients a great deal in the way of lifestyle counselling (OR 1.92; 95%CI: 1.09–3.40) and those cooperating with sports clubs (OR 1.75; 95%CI: 1.03–2.96) were more likely to provide physical activity promotion. Conclusion: There is a need for interventions to increase the frequency of physical activity promotion by primary care physicians. In particular physicians in rural regions should be assisted and cooperation activities with sports clubs or other health care providers should be encouraged.     

Frailty Predicts Increased Health Care Utilization Among Community-Dwelling Older Adults: A Longitudinal Study in China

ObjectivesFrailty, a multidimensional syndrome characterized by vulnerability to stressors, is an emerging public health priority with high prevalence in older adults. Frailty has been identified to predictive negative health outcomes, yet quantified evidence regarding its effect on health care systems is scarce. This study examines how frailty affects health care utilization, and explores whether these associations varied by gender.DesignCohort study with a 2-year follow-up.Settingand Participants: Data were derived from 2 waves (2011 and 2013) of the China Health and Retirement Longitudinal Study, and 3119 community-dwelling participants aged ≥60 years were analyzed.MethodsFrailty was assessed by a validated frailty phenotype scale, and measures for health care utilization were self-reported. Panel data approach of mixed-effects regression models was used to examine the associations.ResultsLongitudinal results demonstrated that compared with robustness, prefrailty and frailty were both significantly associated with increased likelihood of outpatient visit, inpatient visit, and inpatient length of stay, even after adjusting for multimorbidity in multivariate analyses (all P < .05). Every 1-component increase in frailty was also found to significantly increase the risk for health care utilization [any outpatient visit: adjusted odds ratio (OR) 1.30, 95% confidence interval (CI) 1.14–1.48; number of outpatient visits: adjusted incident rate ratio (IRR) 1.34, 95% CI 1.18–1.53; any inpatient visit: adjusted OR 1.44, 95% CI 1.22–1.71; number of inpatient visits: adjusted IRR 1.40, 95% CI 1.20–1.62; inpatient length of stay: adjusted IRR 1.50, 95% CI 1.18–1.92]. The preceding associations were similarly observed irrespective of gender.Conclusions and ImplicationsFrailty is a significant predictor for increased health care utilization among community-dwelling older adults. These findings have important implications for routine clinical practice and public health investment. Early screening and intervention for potentially modifiable frailty could translate into considerable savings for households and health care systems.     

Anxiety and depression predict musculoskeletal disorders in health care workers

Incidence of musculoskeletal disorders (MSDs) is high among health care workers (HCWs). To determine whether MSDs are associated with preexisting anxiety and/or depression, a case-control study was carried out in female HCWs (56 cases/55 controls). Cases were HCWs with a first-time clinical diagnosis of MSD within the previous 2 years. Occupation, workplace, work shift, direct patient assistance, and anxiety/depression scores (Goldberg scale) were assessed. Increased risk of incident MSDs (multivariate logistic regression) was found in workers with preexisting anxiety/depression compared to those without (OR 5.01; 95% CI 2.20–12.05; p < .01). Other significant risk factors were direct patient assistance (OR 2.59; 95% CI 1.03–6.92; p = .04) and morning work shift (OR 2.47; 95% CI 0.99–6.48; p = .05). Preexisting anxiety/depression was associated with incident MSDs in HCWs, adjusting for occupational exposure risk factors.     

Beyond community-based diabetes management and the COAG coordinated care trial

Objective: This article describes the patient management processes developed during the Council of Australian Governments (COAG) coordinated care trial and use of health outcome measures to monitor changes in utilisation patterns and patient well‐being over time for a subgroup of 398 patients with type 2 diabetes. Design: The Eyre component of the South Australian (SA) HealthPlus coordinated care trial was a matched geographically controlled study in which the outcomes for the intervention group of 1350 patients were compared with those of a similar control group of 500 patients in another rural health region in SA. Setting: The trial was carried out on Eyre Peninsula in SA across populations in rural communities and in the main centres of Whyalla, Port Lincoln and Ceduna. Care planning was organised through general practitioner practices and services negotiated with allied health services and hospitals to meet patient needs. Subjects: The SA HealthPlus trial included 1350 patients with chronic and complex illness. A subset of this group comprising 398 patients with type 2 diabetes is described in this report. Patients recruited into the three‐year trial were care planned using a patient centred care planning model through which patient goals were generated along with medical management goals developed by clinicians and primary health care professionals. Relevant health services were scheduled in line with best practice and care plans were reviewed each year. Patient service utilisation, progress towards achieving health related goals and patient health outcomes were recorded and assessed to determine improvements in health and well‐being along with the cost and profile of the services provided. Results: Significant numbers of patients experienced improved health outcomes as a consequence of their involvement in the trial, and utilisation data showed reductions in hospital and medical expenditure for some patients. These results suggest that methods applied in the SA HealthPlus coordinated care trial have led to improvements in health outcomes for patients with diabetes and other chronic illnesses. In addition, the processes associated with the COAG trial motivated significant organisational change in the Regional Health Service as well as providing an opportunity to study the health and well‐being outcomes resulting from a major community health intervention. Conclusions: The importance of the SA HealthPlus trial has been the demonstrated link between a formal research trial and significant developments in the larger health system with the trial not only leading to improvements in clinical outcomes for patients, but also acting as a catalyst for organisational reform. We now need to look beyond the illness focus of health outcome research to develop population based health approaches to improving overall community well‐being. What is already known: Much work has been completed in recent years tracing the clinical impact of more effective management of patients with chronic illness. Evidence suggests that more structured management of patient care and better access resources and support can improve patient well‐being and reduce demand on acute care services. What is needed, however, are mechanisms for managing patients to access relevant care and to comply with best practice protocols. Lowered HbA1c readings correlate with reduced crises for diabetic patients, but how can we encourage patients to engage in practices that actually lower these levels? What this study adds: The current study, based on work carried out during the COAG coordinated care trials, suggests that a structured patient centred care planning process can improve patient knowledge of their condition and increase motivation for sustainable behaviour change in the way they manage their illness. These processes of patient engagement and symptom monitoring have led to better long‐term health and well‐being for patients with diabetes. The wider application of such processes of care management will be an important next step in improving the management of health and well‐being at larger population levels.     

GP Clinic: promoting access to primary health care for mental health service clients

Objective: To evaluate an innovative rural service offering comprehensive primary health care for mental health service clients. Design: A formative evaluation using mixed methods. Setting: A rural NSW community. Participants: Fifteen health care providers and 120 adult clients. Intervention: A monthly clinic held in a general practice to provide primary health care for clients of the community mental health team. Main outcome measures: Client utilisation and clinic activity data. Provider views of service effectiveness, possible improvements and sustainability. Results: The GP Clinic has operated successfully for 2.5 years without access block. Some 52% of clients had no physical illness and 82% were referred to other health and community services. In total, 40% continued to attend the clinic while 32% went on to consult a GP independently. Client access to care improved as did collaboration between the community mental health team and primary care providers. Conclusion: The GP Clinic is a straightforward and flexible service model that could be used more widely.     

Do Sociodemographic Characteristics of Pregnant Women Determine their Perception of Antenatal Care Quality?

Objectives To explore sociodemographic determinants of perceived quality of antenatal care (ANC) at the primary care level. Methods A survey of 452 randomly selected pregnant women accessing antenatal care at the primary healthcare facilities in Sagamu Local Government Area (LGA) of Ogun State, southwest Nigeria. The relationships between 13 sociodemographic characteristics of women and their overall perception of the quality of care (expressed by their level of overall satisfaction) were examined through bivariate analyses, by computing odds ratio at 95% confidence interval. Multivariate logistic regression analyses were used to determine independent sociodemographic determinants of overall satisfaction with quality of care received. A P-value <0.05 or CI which did not embrace unity was considered as statistical significance. Results From bivariate analyses, increasing parity, increasing number of living children, gainful employment of client and Islamic religion increases the likelihood of positive perception of antenatal care quality. Characteristics such as age, being married, women’s monthly earning, ethnicity, employment status of husband, educational level, duration of pregnancy, frequency of antenatal visits, and previous use of antenatal care at the same centre were not associated with overall satisfaction with antenatal care quality. Independent predictors from multivariate regression analyses include parity (adjusted OR 0.13; CI: 0.05–0.33, P = 0.005) and religion (other religions vs. Islam; adjusted OR: 0.14, CI: 0.04–0.40, P = 0.0003). Conclusions The study suggests that sociodemographic characteristics of women have limited impact on their perception of ANC quality. The identified predictors may serve as the criteria for selecting women that require intensive health centre-specific antenatal interventions aimed at improving perceived quality and thus sustained utilization of antenatal care services in these primary health care facilities.     

Use of Social Services by Pregnant Medicaid Eligible Women in Baltimore

Objectives: To use linked health and social service databases to determine differences in the use of social services by pregnant women in different managed care systems. Methods: Comparison of service use by women enrolled in a fee-for-service primary care case management program (Maryland Access to Care or MAC), in a capitated health maintenance organization (HMO), or not assigned to managed care using six state databases. Participants included 5181 women receiving Medical Assistance (MA) and delivering in Baltimore City in 1993. Outcome measures were receipt of WIC, AFDC, and Food Stamps. Results: The overall proportions of women receiving WIC, AFDC, and Food Stamps at delivery were 52.7%, 89.2%, and 62.7%, respectively. Women enrolled in an HMO at delivery were less likely to be receiving WIC (adjusted odds ratios, 0.8, 95% CI, 0.69 to 0.93), AFDC (OR, 0.20; CI, 0.03 to 0.43 for women with prior children and OR 0.13; CI, 0.09 to 0.20 for women without prior children), and Food Stamps (OR 0.77; CI, 0.59 to 0.95 for women with prior children and OR, 0.49; CI, 0.35 to 0.67 for women without prior children) than their MAC counterparts. Women not assigned to managed care also generally were less likely than their MAC counterparts to receive WIC (OR 0.55; CI, 0.46, 0.66), AFDC (OR 1.07; CI 0.83,1.30 for women with prior children and OR 0.24; CI 0.18,0.34 for women without prior children), and Food Stamps (OR 0.31; CI 0.08, 0.55 for women with prior children and OR 0.31; CI 0.23, 0.41 for women without prior children). Conclusions: Although many low-income pregnant women qualify for select social services, receipt of WIC and Food Stamps was low. Increasing efforts are needed by managed care systems and public health agencies to ensure delivery of appropriate services for women.     

Evaluation of prediction strategy and care coordination for COPD readmissions

Objectives: Factors that influence the likelihood of readmission for chronic obstructive pulmonary disease (COPD) patients and the impact of posthospital care coordination remain uncertain. LACE index (L = length of stay, A = Acuity of admission; C = Charlson comorbidity index; E = No. of emergency department (ED) visits in last 6 months) is a validated tool for predicting 30-days readmissions for general medicine patients. We aimed to identify variables predictive of COPD readmissions including LACE index and determine the impact of a novel care management process on 30-day all-cause readmission rate.

Methods: In a case-control design, potential readmission predictors including LACE index were analyzed using multivariable logistic regression for 461 COPD patients between January-October 2013. Patients with a high LACE index at discharge began receiving care coordination in July 2013. We tested for association between readmission and receipt of care coordination between July-October 2013. Care coordination consists of a telephone call from the care manager who: 1) reviews discharge instructions and medication reconciliation; 2) emphasizes importance of medication adherence; 3) makes a follow-up appointment with primary care physician within 1–2 weeks and; 4) makes an emergency back-up plan.

Results: COPD readmission rate was 16.5%. An adjusted LACE index of ≥ 13 was not associated with readmission (p = 0.186). Significant predictors included female gender (odds ratio [OR] 0.51, 95% confidence interval [CI] 0.29–0.91, p = 0.021); discharge to skilled nursing facility (OR 3.03, 95% CI 1.36–6.75, p = 0.007); 4–6 comorbid illnesses (OR 9.21, 95% CI 1.17–76.62, p = 0.035) and ≥ 4 ED visits in previous 6 months (OR 6.40, 95% CI 1.25–32.87, p = 0.026). Out of 119 patients discharged between July-October 2013, 41% received the care coordination. The readmission rate in the intervention group was 14.3% compared to 18.6% in controls (p = 0.62).

Conclusions: Factors influencing COPD readmissions are complex and poorly understood. LACE index did not predict 30-days all-cause COPD readmissions. Posthospital care coordination for transition of care from hospital to the community showed a 4.3% reduction in the 30-days all-cause readmission rate which did not reach statistical significance (p = 0.62).