C35-08 Regional Variation in Effectiveness and Implementation of COPD Transitions of Care: Findings From the Reduce Revisits Study

Abstract Rationale Chronic Obstructive Pulmonary Disease (COPD) affects nearly 16 million U.S. adults and is the fourth leading cause of death worldwide. Implementation of COPD transition of care (TOC) interventions varies widely across hospitals. We evaluated whether regional variations exist in the effectiveness and implementation of COPD TOC interventions among hospitals enrolled in the “Reduce REVISITS” study. Methods This is a sub-analysis of a type II hybrid implementation-effectiveness cluster randomized trial examining one-year implementation of COPD TOC programs across U.S. hospital sites. We analyzed enrolled hospitals according to their U.S. region (West, Northeast, South, Midwest), regardless of randomization arm. Primary outcomes included effectiveness (COPD-specific 30-day revisits) and implementation (bundle reach). Secondary outcomes included effectiveness (COPD-specific 90-day revisits, all-cause 30 and 90-day revisits) and implementation (reach of each intervention). To evaluate associations of region and outcomes, an adjusted 2-factor GEE model was used. Results Of 21 U.S. hospitals randomized, 19 were analyzed (one left the study; one was missing data). Across regions, roughly ½ of patients were female (range: 50-59%), most were white (range: 50-81%), and mean age ranged from 66-70 years. The odds of a COPD 30-day revisit among sites in the West region (n = 2), Northeast region (n = 6), and South (n = 4) were 84% lower (3.9%; OR: 0.16, 0.09, 0.26; p 0.0001), 75% lower (5.8%; OR: 0.25, [0.19, 0.33 p 0.0001), and 5% lower (18.8%; OR: 0.95, 0.77, 1.18; p = 0.6), respectively, compared to the Midwest (n = 7; 16.4%). The odds of the secondary effectiveness outcomes were significantly lower in the West region compared to the Midwest region (Table 1). The Northeast only had significantly lower odds for 90-day revisits due to COPD compared to the Midwest region (0.21 95% CI: 0.17, 0.26, p 0.001). The South region remained not significantly different compared to the Midwest for all secondary outcomes. The Northeast had significantly higher TOC bundle reach compared to the South (38% vs 25%, p 0.007) though individual intervention reach was not significant for any region (all p 0.5) (Table 1). Conclusion These preliminary analyses indicate that regional variation in effectiveness and implementation of COPD TOC programs exists across U.S. hospitals. Hospitals in the West and Northeast demonstrated superior outcomes compared with those in the South and Midwest. Future analyses should explore contextual, policy, and resource factors contributing to these regional differences to inform targeted implementation support strategies. This abstract is funded by: NHLBI