Forward the topic of the health policy paper to faculty at the end of Week One,

Health policy unfolds daily and drives clinical practice in the US. The student will investigate current policies or legislation underway for a specific health-related issue. The Student will develop a scholarly APA formatted paper supported by evidence. The policy paper rubric:

Introduction to population or problem (incidence, prevalence, epidemiology, cost burden etc)

Description of how the policy is intended for a specific population, program or organization

Specific legislators involved in the policy development and dissemination

Identify the role of the APRN in assisting with the policy or refuting the policy – this requires the evidence to support opinion, ideas and/or concepts.

Discuss how the policy influences clinical practice and is used to promote best outcomes

Examine how the policy can be used by the interprofessional team to ensure coordinated and comprehensive care for the specific population

Conclusion – summarize findings

APA format – use of primary peer-reviewed references as much as possible

Submission Details:

• Support your responses with examples.
• Cite any sources in APA format.

Running head: REDUCING COPD REAMISSION RATE 1

REDUCING COPD READMISSION RATE 2

Reducing COPD Readmission Rate for those Aged between 75-80

Student’s Name: Kenya Leyva

Institutional Affiliation South University

Introduction

Chronic Obstructive Pulmonary Disease (COPD) is in the third position globally among diseases, killing most people. It is also a major cause of early mortality rates. COPD is also associated with high costs annually, with each patient paying about $9,800 for treatment in the United States (Halpin et al., 2017). Researchers projected that COPD would be the third leading cause of mortality across the world by 2020. The disease’s mode of transmission and treatment is different for various age groups. Healthy people 2020 shows that 23.3% of COPD patients with the age of 45 years suffer from breathing and chronic lung problem, which causes activity limitations. The target of the initiative is to reduce the number of patients to 18.7 percent.

Disease

Chronic obstructive pulmonary disease (COPD) is a dangerous lung disease that is progressive and life-threatening. Patients initially experience breathlessness followed by affects and exacerbations and may end in severe illness. Various small airways diseases cause it. The pathological changes of COPD are acute inflammation, structural changes due to progressive injury, and more. When the disease severity reduces, the inflammatory changes in airways increase. Moreover, it perseveres upon smoking cessation.

Incidence

The global burden of diseases suggests that, in 2016, there were over 250 million COPD cases. In the previous year, about 5% of all deaths resulted from COPD deaths. The recent prevalence was 17.8%, which was found under a post-bronchodilator assessment. The incidence of COPD has always been higher in men than in women.

Prevalence

Studies have explained the prevalence of COPD in Africa and Asia, but the spirometric data has not been used. It is challenging to define COPD in these nations since other respiratory diseases are prevalent; for example, tuberculosis. This condition is worsened by tobacco smoking. A study taken in 12 Asian countries for prevalence showed china and Vietnam led with 6.5% and 6.7%, respectively (Khakban et al., 2015).

Age is a huge factor in the prevalence of chronic diseases. A study in South Africa involving persons above 15 years showed that males had a prevalence of 2.3% while the females were 2.8%. A similar study to South Americans aged 40 and above showed 7.8% and 20%. In a survey of a developed country, France, the mean age was 33, and the results were 8.6% and 9% for men and women (Halpin et al., 2017). This study showed that the numbers are almost equal in France compared to the disparities in African and Asian countries.

Epidemiology

According to the statistics of the World Health Organization, about 251 million cases of COPD were reported in 2016, as noted by the Global Burden of Disease Study. The disease is estimated to have caused 3.17 million deaths in 2015 (WHO, 2020). About 90% of people who die from COPD are from developing countries that are prone to low incomes.

Cost

COPD is linked to a substantial economic burden. In 2010, about $50 billion was used on the disease, whereby $30 billion was used in direct health services, and $20 billion was spent indirectly (Khakban et al., 2015). The costs are anticipated to rise with the disease increase. In the European Union, about 38.6 billion euros (56%) of the healthcare budget was spent on COPD. The indirect cost was $20.4 billion, while the direct cost was $32 billion. These costs increase as the severity of the disease rises recommending ambulatory oxygen use.

Description

Morbidity: It involves the emergency department, physician visits, and hospitalizations. Studies have found that despite the unavailability of COPD databases, its morbidity increases with an age increase (Saunier, 2017). Besides, comorbidities can be noticed at an earlier age for some patients. Other chronic disorders such as musculoskeletal impairment, cardiovascular disease, and diabetes may affect morbidity from COPD.

Mortality: WHO provides statistics on death and the causes in all its member countries. Nevertheless, COPD is usually misinterpreted, which can lead to an incorrect reading of data. From its Evidence for Health Policy Department, COPD deaths are grouped under “COPD and allied conditions” as a broad category. However, some countries do not record mortality, but rather a current hospitalization. COPD is one of the most checked since it is a leading cause of death; for instance, in 2011, it was the leading killer illness in the U.S.

Population

When addressing COPD, age is a risk factor. No research shows whether aging in a healthy way can result in COPD or whether it depends on all exposures a person has in their life. From the studies above, it can be concluded that prevalence and mortality are higher among males than females. Recent studies of developed countries show that the numbers are almost equal for all genders, which may be due to different behavior in smoking (WHO, 2020). Research shows that women are more vulnerable to tobacco smoke than men, which accelerates the disease. Further pathology specimens and animal studies have confirmed this argument, which explains why women strain with small airway diseases more than men despite both having similar tobacco exposure.

Specific Legislators

There are high cases of hospital readmissions on elderly patients and in other cohorts. This lead to the establishment of the Hospital Readmissions Reduction Program (HRRP). Patients incur a lot of charges when they revisit hospitals or get re-hospitalized. HRRP helps to minimize payments to medical centers with many readmissions. It was developed under an act of parliament and supported the national goal of quality health services.

The Secretary of the Department of Health and Human Services, under section 3025 of the Affordable Care Act, should initiate HRRP and minimize costs by IPPS (Inpatient Prospective Payment System), especially for medical centers with excess rehospitalization, taking effect from 1st October 2012 (Ibrahim et al., 2018). Also, CMS should evaluate a hospital’s performance in relation to others with the same amount of patients who have met requirements for Medicaid and Medicare as of F.Y. 2019 (the 21 century Cures Act) (Halpin et al., 2017).

In its 30-day risk-standardized unorganized rehospitalization program, CMS considers diseases such as COPD, Acute Myocardial Infarction, Heart failure, and more (Ibrahim et al., 2018). For all Medicare fee-for-service, payment reductions are applied depending on DRG payments. The payment adjustment is based on a three-year performance of the hospitals. The payment adjustment factor is 0.97, which yields a 3% reduction for F.Y. 2020. All hospitals are required to calculate payments and send reports to HRRP. They are reviewed and forwarded for correction if need be.

Policy

Researchers argue that smoking cessation is one of the most effective policies to lower the scope of COPD. It also minimizes mortality for half of the population living with COPD (Bai et al., 2017). Behavioral support may be less effective than when it is combined with medication. Smoking tobacco can lead to the severity of COPD; thus, such policies are necessary to minimize adverse effects.

Additionally, BTS recommendations are crucial policies. In order to improve care and decrease rehospitalization frequency for COPD patients, BTS formed COPD Admission and Discharge Care Bundles. For instance, in the U.K., clinical staff use Care Bundles. It is recommended that the element of the bundles cannot be altered, but the document can be adjusted for various jurisdictions.

Interprofessional Team

The interprofessional team in clinical practice helps to manage a variety of conditions such as COPD. Its care service forms a model for the application of teamwork. A post-acute care establishment can be used to manage chronic diseases by positioning a clinical pharmacist in a unique manner. Studies have classified pharmacists as a crucial member of the interprofessional team when patients are undergoing transitions (Saunier, 2017). Significant benefits that pharmacists have achieved through medication reconciliation relative to regular care include; a relative risk reduction of 28% for E.D. visits, and a relative risk reduction of 67% for hospital revisits for adverse drug effects (Halpin et al., 2017). Thus, pharmacists are prescribers for disorders management.

Additionally, the COPD foundation facilitates the interprofessional COPD CARE team services by recommending the use of a care model that is proactive and team-based. This is crucial for proper care transitions and allows all team members to coordinate effectively during a hospital stay and after discharging patients (Saunier, 2017). Every team member has their role articulated in the COPD CARE service. Other care practices that COPD Foundation recommends are pulmonary rehabilitation, use of spirometers, and referral to motivational interviewing for tobacco treatment.

Conclusion

Chronic Obstructive Pulmonary Disease is a condition that affects the airways and hinders breathing. This condition has become one of the leading causes of deaths across the globe. Notably, it is identified by inflammation in the airways and shortness of breath. The disease has been associated with a high number of hospital readmissions, especially for elderly patients. The prevalence of the disease is high in men than in women for middle-income countries. Also, its incidence depends on age, with the older people having more severity of the disease. Besides, COPD is increased by exposure to tobacco. Different policies, such as tobacco cessation and BTS recommendations can be applied to minimize the side effects. Also, legislative laws of the Hospital Readmissions Reduction Program helps to improve patient care by punishing hospitals with high readmissions within 30 days of discharging patients.

References

Bai, J. W., Chen, X. X., Liu, S., Yu, L., & Xu, J. F. (2017). Smoking cessation affects the natural history of COPD. International journal of chronic obstructive pulmonary disease, 12, 3323.

Halpin, D. M., Miravitlles, M., Metzdorf, N., & Celli, B. (2017). Impact and prevention of severe exacerbations of COPD: a review of the evidence. International journal of chronic obstructive pulmonary disease, 12, 2891.

Ibrahim, A. M., Dimick, J. B., Sinha, S. S., Hollingsworth, J. M., Nuliyalu, U., & Ryan, A. M. (2018). Association of coded severity with readmission reduction after the Hospital Readmissions Reduction Program. JAMA internal medicine, 178(2), 290-292.

Khakban, A., Sin, D. D., FitzGerald, J. M., Ng, R., Zafarí, Z., McManus, B., … & Sadatsafavi, M. (2015). Ten-year trends in direct costs of COPD: a population-based study. Chest, 148(3), 640-646.

Saunier, D. T. (2017). Creating an interprofessional team and discharge planning guide to decrease hospital readmissions for COPD. MedSurg Nursing, 26(4), 258.

WHO. (2020). Chronic obstructive pulmonary disease (COPD). Retrieved 23 August 2020, from https://www.who.int/news-room/fact-sheets/detail/chronic-obstructive-pulmonary-disease-(copd)