Introduction: Elderly patients with advanced COPD requiring noninvasive respiratory support during the index hospitalization are at high risk for readmissions, leading to increased healthcare use and poorer outcomes. Early palliative care may reduce unnecessary interventions and improve care transitions. We assessed whether early consultation during the index hospitalization decreases 180-day readmission rates and examined outcomes among those readmitted. Methods: We used ICD-10 codes in the National Readmission Database (NRD-2022) to identify patients aged 70 or older with advanced COPD (COPD+ on home oxygen) who required noninvasive ventilation (NIV) or high-flow oxygen (HHF) support during the initial admission. ICU patients or those who died during the initial admission were excluded. The cohort was grouped based on the index admission palliative care consult. Outcomes were all-cause 180-day readmission, and among readmitted, length of stay, IMV use, hospital charges, and discharge disposition. We used a multivariate regression analysis model and adjusted odds ratios (aOR). Results: Among 17, 914 patients with advanced COPD managed with NIV or high-flow oxygen in a non-ICU setting, the median age was 74 years, and 56% were female. . Early palliative care consultation was associated with significantly lower odds of 180-day readmission (aOR 0. 22; p< 0. 001). Of the 22% who were readmitted, outcomes were notably worse compared to their initial admission, including higher rates of invasive mechanical ventilation (aOR 3. 10; p< 0. 001), increased likelihood of non-home discharge (aOR 3. 08; p< 0. 001), more extended hospital stays (+6. 1 days; p< 0. 001), and greater hospitalization costs (+68, 263; p< 0. 001). Conclusions: Our analysis showed that, among elderly patients with advanced COPD who need NIV/HHF during index admission, palliative care consultation was associated with a significant reduction in 180-day readmissions. Integrating palliative care into the management of advanced COPD may help reduce avoidable hospitalizations and align care with value-based models. Future efforts should prioritize expanding timely access to palliative interventions for this high-risk population.
Khan et al. (Sun,) studied this question.