Leveraging Electronic Health Record for Identifying At-Risk COPD Patients
Explore how UNC is using electronic health records to identify at-risk COPD patients and reduce readmissions. Gain insights into the scope of the problem, current resources, and pilot programs at UNC Memorial/Hillsborough Hospital. Understand readmission rates and Medicare data for COPD patients to improve care outcomes.
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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 brad_drummond@med.unc.edu
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
UNC Memorial/Hillsborough Hospital Discharges: Principal diagnosis COPD 100 87 90 83 80 74 73 Total=854 (71/mo) 70 69 69 68 68 66 70 64 63 No. of Discharges 60 48 48 47 47 50 44 44 Inpt=519 (43/mo) 42 42 42 40 39 36 40 26 30 21 ED=174 (15/mo) 16 16 15 20 14 13 13 12 12 9 7 10 Obs=161 (13/mo) 0 2017-07 2017-08 2017-09 2017-10 2017-11 2017-12 2018-01 2018-02 2018-03 2018-04 2018-05 2018-06 Total Inpatient Observation ED 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)
UNC Memorial/Hillsborough Hospital Discharges: Principal diagnosis COPD by County Rockingham Caswell Person Granville 1% 1% 0% 1% Guilford 2% 13% 19%5% Wake 8% Randolph Chatham 2% Pitt 6% 2% Harnett 2% Cumberland Sampson 2% 3% Onslow 2% Data courtesy Scott Keller (UNC) N=496 inpatient admissions
UNC Memorial/Hillsborough Hospital Readmission Rate Average 1-year readmission rate: 16.9% % 30-day Readmission 25.6 23.8 23.8 23.4 21.4 19.1 17.5 12.8 11.4 10.4 7.1 7.0 6.9 5.6 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)
UNC COPD Discharges and Readmission: Medicare Data 7/1/13-6/30-16 948 1000 Discharge Readmissions 900 UNC 30-day COPD readmission rate: 19% 800 Number of Patients 661 700 591 600 497 500 381 400 341 328 300 205 179 200 130 112 110 80 73 58 100 34 0 UNC Duke NC Baptist Rex Nash WakeMed Raleigh Moses Cone Cape Fear Data courtesy John Vargas (UNC) Source: https://data.medicare.gov/Hospital-Compare/Hospital-Readmission-Rates/92ps-fthr/data#revert
North Carolina COPD Readmission Ratio Graph courtesy John Vargas (UNC) Source: https://data.medicare.gov/Hospital-Compare/Hospital-Readmission-Rates/92ps-fthr/data#revert
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 https://www.med.unc.edu/pulmonary/ 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
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
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
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
