Chronic obstructive pulmonary disease (COPD) is the third leading cause of death and hospital readmissions in the US, particularly for patients aged 65 and older. The Medicare Hospital Readmissions Reduction Program (HRRP), as part of its mandate to improve quality and cut costs, penalizes hospitals for exceeding the expected 30-day readmission rate after discharge following an acute exacerbation of COPD (AECOPD). In response, hospitals are formulating quality improvement interventions despite a lack of evidence that these interventions are effective. We run a multidisciplinary, coordinated-care program to reduce COPD readmissions at the University of Chicago Medicine (UCM). Reducing preventable readmissions for patients with COPD is a priority for hospitals facing HRRP penalties. Efforts will require a comprehensive and innovative approach. Improving patients' self-management is critical.

Through this inter-professional quality improvement initiatives, we have several objectives. First, we are determining if our multi-faceted program can reduce readmissions. Second, we are analyzing if the program is cost-efficient, when factoring in potential reduced penalties from Medicare versus the costs of the program itself. Further, we are working to identify higher risk sub-populations, including frail seniors, to determine if additional program elements are required to reduce frail seniors' risks for readmissions. Finally, we are developing and testing innovative technology-based interventions to improve care transitions and self-management at home. For our frail senior patients, we are also utilizing an accelerometer, similar to a Fitbit or other fitness trackers, to determine the influence of activity levels post-discharge on hospital readmissions.

1) To determine the effectiveness of a multi-component inter-professional team-based approach to improving hospital-based care for inpatients with COPD to reduce readmissions (QI project)

2) To determine the cost-efficiency of this multi-component inter-professional team-based approach (Cost-effectiveness project)

3) To determine the utility of a comprehensive, multidisciplinary, coordinated-care program for senior frail patients with COPD utilizing novel hip accelerometry to monitor activity and sleep at home after discharge (Observational study)

4) To evaluate the impact of a medical education program to engage medical students as part of the inter-professional team through value-added roles (Medical education project)

Study participants will be recruited from patients participating in the COPD readmissions reduction program. A subset of patients will be approached for each study, based on eligibility criteria, and will be enrolled. Students will participate in enrolling participants, completing the assessments, analyzing preliminary results, and being part of the QI team to continue to refine and improve our COPD program.

STATA

The student will be expected to participate in weekly research group meetings and is encouraged to attend a weekly Outcomes Research Workshop. Final work will be considered for national annual conferences, such as Society of Hospital Medicine or American Thoracic Society.