CHEST Guidelines-Association-Between-Postdischarge-Pulmonologist-Vi

Association-Between-Postdischarge-Pulmonologist-Vi

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The correspondence addresses the study by Gavish et al., published in CHEST, which investigates the link between post-discharge pulmonologist visits and hospital readmission rates for COPD patients. The study implies that early pulmonologist follow-ups can reduce hospitalizations due to COPD exacerbations. However, Umur Hatipoğlu, MD, and Xiaofeng Wang, PhD, from the Cleveland Clinic raise concerns about the study's applicability and methodology.<br /><br />They argue that the study's use of COPD exacerbations as an endpoint may not align with the broader scope of the Hospital Readmissions Reduction Program in the U.S., which focuses on all-cause readmissions to prevent misclassification and manipulation of data. The authors note that only a small percentage of readmissions after a COPD-related hospitalization are actually due to COPD, suggesting that specialist interventions alone may not significantly impact overall readmissions.<br /><br />The correspondence also highlights a potential methodological issue with the study's multivariate logistic regression models. Specifically, previous pulmonologist visits were a factor in predicting which patients are less likely to miss follow-ups but were not included as a covariate in models predicting 90-day readmissions. This omission might overlook the influence of established specialist care on readmission risks.<br /><br />The authors seek clarification on whether previous pulmonologist visits were considered in the regression models and question how other variables, such as the number of hospitalizations and office visit frequency in the prior year, were classified in the study's analysis. They advocate for careful variable selection to ensure that the study's findings are robust and applicable.

Keywords

COPD

hospital readmissions

pulmonologist follow-ups

Gavish et al.

CHEST journal

Cleveland Clinic

methodology concerns

multivariate logistic regression

Hospital Readmissions Reduction Program

specialist interventions