Health Sciences Program Student Theses, Dissertations and Capstones

Document Type

Dissertation - NSU Access Only

Degree Name

Doctor of Philosophy (PhD) in Health Science

Copyright Statement

All rights reserved. This publication is intended for use solely by faculty, students, and staff of Nova Southeastern University. No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, now known or later developed, including but not limited to photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author or the publisher.

Department

College of Health Care Sciences – Health Science Department

First Advisor

Moya Alfonso

Second Advisor

Guy Nehrenz

Date of original Performance / Presentation

January 2023

Publication Date / Copyright Date

1-1-2023

Abstract

Identifying persons with chronic obstructive pulmonary disease (COPD) at high risk for hospital readmission through predictive tools allows for opportunities to provide efficient and appropriate care, which may lower readmission risk, reduce associated costs, and curb excess related 30-day readmission penalties. This retrospective cohort dissertation study examined the 30- and 60-day readmission prediction of the COPD readmission (CORE) score and sought to improve its viability by adding new predictors to comprise the CORE+ score. Further, the relationship of CORE and CORE+ scores with hospital outcomes was investigated. The association between covariates and outcomes was assessed using Chi square tests and Fisher’s exact tests. A Wilcoxon signed-rank test compared the mean ranks of CORE and CORE+ scores and evaluated their relationship with hospital outcomes. Thirty and 60-day readmission rate predictive power was assessed using multiple logistic regression. Predictive accuracy was assessed by the area under the curve (AUC) of receiver operator characteristics (ROC). A total of 391 participants were included. The CORE+ score had better accuracy than the CORE score for correctly predicting 30-day readmission (AUC = 0.81, 95% CI (0.76-0.86), AUC = 0.73, 95% CI (0.66-0.79), p < .001) and 60-day readmission (AUC = 0.77, 95% CI (0.71-0.83), AUC = 0.75, 95% CI (0.69-0.81), p < .001). Participants who utilized in-hospital noninvasive positive pressure ventilation (NIPPV) had higher mean CORE and CORE+ scores compared with those who did not (p = .029, p = .003, respectively). The CORE and CORE+ scores offer accurate tools for 30- and 60-day readmission prediction as they demonstrated moderate to excellent accuracy in participants with COPD.

Disciplines

Medicine and Health Sciences

Keywords

COPD; Hospital Readmissions; Lung disease; Readmission Prediction; Sixty-Day Readmission; Thirty-Day Readmission

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