Key result
Providers at VA sites with low COPD readmission rates reported practice environments with higher relational coordination and fewer structural barriers compared to sites with high readmission rates.
Why the study?
Improving COPD care and reducing readmissions is an urgent priority, but little is known about the organizational factors underlying intersite variation in readmission rates.
What organizational factors and care coordination practices differentiate VA sites with low vs. high COPD readmission rates?
Observational (n=25)
Yes
What organizational factors and care coordination practices differentiate VA sites with low vs. high COPD readmission rates?
High relational coordination and fewer structural barriers, rather than specific readmission reduction initiatives, distinguish VA sites with low COPD readmission rates.
May support targeting relational coordination in VA COPD care; observational data leaves causal effects on readmissions open.
OBJECTIVES: Improving chronic obstructive pulmonary disease (COPD) care and reducing hospital readmissions is an urgent healthcare system priority. However, little is known about the organizational factors that underlie intersite variation in readmission rates. Evidence from other chronic diseases points to care coordination as one such factor. STUDY DESIGN: To understand whether intersite differences in care coordination may be one of the organizational factors contributing to the variation in readmission rates, we examined provider perspectives on COPD care at Veterans Affairs (VA) sites. METHODS: In this mixed-methods positive deviance study, we selected 3 VA sites in the lowest quartile and 3 in the highest quartile for 2016 risk-adjusted COPD readmission rates. During June to October 2017, we conducted semistructured interviews with primary and specialty care providers involved in COPD care at VA sites with low (n = 14) and high (n = 11) readmission rates. RESULTS: Although providers at all sites referenced ongoing readmission reduction initiatives, only providers at low-readmission sites described practice environments characterized by high relational coordination (ie, high-quality work relationships and high-quality communication). They also reported fewer significant structural barriers to collaboration in areas like patient volume. CONCLUSIONS: The most notable differences between high- and low-readmission sites were related to the quality of relational coordination and the presence of structural barriers to coordination, rather than specific readmission reduction initiatives. Implementing organizational reforms aimed at enhancing relational coordination and removing structural barriers would enhance care for COPD and may improve quality of care for other chronic conditions.
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P Anderson (2020) conducted an observational in Chronic obstructive pulmonary disease (COPD) (n=25). High relational coordination and fewer structural barriers vs. High-readmission sites (lower relational coordination) was evaluated on Differences in relational coordination and structural barriers between high- and low-readmission sites. Providers at VA sites with low COPD readmission rates reported practice environments with higher relational coordination and fewer structural barriers compared to sites with high readmission rates.
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