Rationale: Although the Hospital Readmission Reduction Program (HRRP) has reduced the 30-day readmission rates for patients with chronic obstructive pulmonary disease (COPD) across hospitals, the effect of HRRP on hospital mortality remains unknown. Therefore, we examined the association between hospital readmissions and mortality rates for patients discharged with acute exacerbation of COPD (AECOPD).
Method: The all-cause hospital-specific 30-day risk-standardized mortality rate (RSMR) and the 30-day risk-standardized readmission rate (RSRR) for patients with COPD from 2010 to 2017 were obtained from the Hospital Compare website. Hospital service area (HSA) information was obtained from the Dartmouth Atlas of Healthcare. The longitudinal relationship between the mortality and readmission rates of a hospital was assessed using mixed linear models.
Results: Of the 3,685 hospitals analyzed, the unadjusted mean RSMRs increased from 7.8% to 8.4% during the study period at a yearly rate of 0.13 (95% CI = 0.12 to 0.14; P < .001), whereas the mean RSRRs declined from 20.7% to 19.6%. When examined according to the baseline readmission rate and interaction with time, each 1% higher-than-baseline readmission rate was associated with a smaller increase in mortality rate by 0.015% (95% CI = -0.02 to -0.01; P < .0001). Inclusion of change in readmissions in the model showed that each 1% decrease in readmission rate was associated with 0.04% (95% CI = -0.01 to -0.06; P = .008) increase in mortality.
Conclusion: This hospital-level analysis of AECOPD showed that although the 30-day all-cause readmission rates declined, the mortality rates increased. Hospitals with lower readmission rates had higher mortality rates over time.