Gadd, Holly

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Due to elevated readmission costs, the Affordable Care Act established the Hospital Readmission Reduction Program in 2012 to curb the 30-day readmission rates. COPD and schizophrenia are two very expensive diseases, COPD national medical costs is projected to be $49.0 billion in 2020; the cost of schizophrenia was 155.7 billion in 2013. The main objective of this study was to determine if schizophrenia is a significant predictor of 30-day readmission following hospitalization for acute exacerbation of COPD after adjusting for age, gender, anxiety, smoking status, T2DM, chronic ischemic heart disease, and GERD. Methods: A retrospective cohort design was used to request data from the South Carolina RFA. Data were from January 1, 1996 to September 30, 2015 with primary or secondary diagnosis of ICD 9 491.21 or 491.22. The RFA created a unique identifier for each patient. Schizophrenia was defined as and ICD 9 diagnostic code of 295.XX. Calculations were initially made in R, then in SPSS. Results: Unadjusted and adjusted analyses per the robust GEE matrix revealed that schizophrenia was not a significant indicator for 30-day COPD readmission (p = 0.105 and 0.054 respectively). However, GEE model-based method indicated that schizophrenia was a significant predictor of 30-day readmission for COPD in both the unadjusted analysis (p = 0.019) and the adjusted analysis (p = 0.002). Conclusion: Although not quite statistically significant per the more reliable robust matrix, the results raise the possibility that schizophrenia could be a predictor of readmission. Further studies using a prospective approach are recommended.

Keywords: COPD, schizophrenia, 30-day readmission.