The impact of Hospital Readmission Reduction Program on chronic obstructive pulmonary disease risk factors: a systematic review

Background: The objective of this systematic review is to summarize and assess the risk factors associated with chronic obstructive pulmonary disease (COPD) readmission following the enactment of the Patient Protection and Affordable Care Act and the Center for Medicare and Medicaid Services' Hospital Readmission Reduction Program in 2015. Before the enactment of the Act, addressing the rising rate of COPD-related readmission was a quality improvement effort. However, the Act allowed for the creation of financial penalties to incentivize these improvements and set the reduction of readmission as a priority. Methods: This study systematically examined electronic databases from 2010-2020. Data were extracted and divided into two time periods: after the introduction of the Patient Protection and Affordable Care Act (2010-2014) and after the addition of COPD as a Hospital Readmission Reduction Program measure (2015-2020). Studies were screened based on inclusion and exclusion criteria. The study was grounded in the Ecological Model to assess COPD readmission risk factors. Results: A total of 30 studies were included in the analysis. At the individual level, comorbidities were the most widely explored risk factors for readmission risk amongst all articles, though 2015-2020 articles introduced behavioral health comorbidities as newly explored risk factors. At the community level, though largely unexplored in 2010-2014 articles, discharge location as a readmission risk factor was examined in several 2015-2020 articles. Conclusions: Overall, no major differences in the types of COPD readmission risk factors examined were found, though new, previously unexplored risk factors were observed. Future research should aim to utilize Centers for Medicare and Medicaid Services Hospital Readmission Reduction Payment readmission data or methodology to gain a comprehensive understanding of the impact of the Hospital Readmission Reduction Program and risk factors for readmission under the program.