Of those patients hopitalized for an exacerbation of COPD, one in five will require rehospitalization within 30 days.  Many developed countries are now implementing policies to increase care quality while controlling costs for COPD, known as value-based health care.  In the United States, COPD is part of Medicare’s Hospital Readmissions Reduction Program (HRRP), which penalizes hospitals ofr excess 30-day, all-cause readmissions after a hospitalization for an acute exacerbation of COPD, despite minimal evidence to guide hospitals on how to reduce readmissions.  This review outlines challenges for improving overall COPD care quality and specifically for the HRRP.  These challenges include heterogeneity in the literature for how COPD and readmissions are defined, difficulty finding the the target population during hospitalizations, and a lack of literature to guide evidences-based programs for COPD readmissions as defined by the HRRP in the hosptal setting. It the identifies risk factors for early readmissions after acute exacerbation of COPD and discusses trested and emerging strategies to reduce thse readmissions.  Finally we evaluate the current HRRP and future plicy changes and their effect on the goal to deliver value-bsed COPD care.  CoPD remains a chronic disease with a high prevalence that has finally garnered the attention of health systems and policy makers, but we still hava long way to to truly deliver-value-based care to patients.

Chest 2016; 150(4):916-926

Recent Advances in Chest Medicine