Over a fifth of patients with Chronic Obstructive Pulmonary Disease (COPD) who have been admitted to the hospital for severe COPD exacerbations get readmitted within one month. The Centers for Medicare and Medicaid (CMS) have mandatory financial penalty programs for excessive COPD readmissions and voluntary value-based payment programs aimed at reducing COPD readmissions. However, despite these efforts through CMS, COPD readmission reduction programs across the US have largely not been successful at preventing readmissions. Our program at University of Chicago has shown positive results. Therefore, we aim to identify, from all relavent stakeholders, what are identifiable, addressable, barriers to preventing COPD readmissions and what are facilitators and/or effective interventions that can effectively reduce COPD readmissions.

1. Among University of Chicago patients with COPD identify barriers and facilitators to improving self-management, symptom control, and avoiding early recurrent acute care utilization (emergency department visits and/or hospitalizations) after an initial hospitalization for COPD.

2. Among University of Chicago health care providers (physicians, nurse practionners, nurses, community health providers) identify barriers and facilitators to aiding patients with self-management skills, improving symptom control, and avoiding early recurrent acute care utilization (emergency department visits and/or hospitalizations) after an initial hospitalization for COPD.

3. Among University of Chicago health leaders/administrators (Chief Quality Officer, Chief Clinical Transformation Officer, among others) identify barriers and facilitators to providing system-based interventions to reduce early recurrent acute care utilization (emergency department visits and/or hospitalizations) after an initial hospitalization for COPD.

We will employ the consolidated framework for implementation science (CFIR) that allows for a systematic approach to design complex, multi-level interventions across multiple stakeholders. Interviews instruments and codebooks will be developed for each stakeholder population with input from our COPD Foundation partner and implementation science consultant (developed CFIR). Analysis plan: Mixed methods and implementation science approaches will be used to analyze data. These methods include qualitative analysis of interviews and quantitative descriptive summaries of survey data followed by triangulation techniques for preparation for tool development. The qualitative interview approach will be one of phenomenology which examines a particular phenomenon, in this case risk of an COPD admission/readmission, through the stakeholders' perceptions of the event. All interviews will be conducted using a semi-structured format and will be audio recorded, transcribed, and de-identified. Thematic analysis of transcripts will be performed, using a deductive approach. Research team members will independently code transcripts for major themes and subthemes and then together will refine the coding framework. Once a framework is established, all transcripts will be reviewed (two coders). To assess inter-rater reliability, Cohen's kappa will be calculated with 95% confidence interval. All qualitative analysis of the data, including retrieving, coding, and sorting of the data, will be completed using NVivo software. We will modify the downloadable NVivo codebook from the CFIR website. The quantitative methods will use descriptive statistics to summarize the types and counts of risk factors identified. Stata 15 will be used for quantitative analyses.

Stata and Atlas.ti or NVivo (will be supplied by lab)

Outcomes Research Workshop