The Impact of Schizophrenia on COPD Readmission Rate Among Hospitalized South Carolinians

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.