D028 Advanced Health Assessments for Patients and
Populations CPE - Hospital Readmissions Reduction Program: A
Case Study on COPD Western Governors University
The Hospital Readmissions Reduction Program is a program managed by the Centers for Medicare and
Medicaid services which aims to reduce unnecessary hospital readmissions. The program incentivizes
hospitals to provide high quality care during and after a patient’s stay by facing financial penalties if they
have excessive readmission rates within 30 days of discharge. The hospital is compared to national
benchmarks of readmission rates to ensure they are providing proper care coordination, patient
education, and post-discharge planning.
The program currently looks at numbers for acute myocardial infarctions, chronic obstructive
pulmonary disease, heart failure, pneumonia, coronary artery bypass grafts, and elective primary total
knee/hip arthroplasty. The advanced professional nurse is able to utilize this program to help promote
better health outcomes by identifying high risk patients early in their hospital stay, strengthen
interdisciplinary communication and care coordination which promotes more comprehensive care,
, improve transitional care and ensuring that patients understand their discharge instructions, and help
support health equity by recognizing the social determinants of health that often lead to readmissions.
All of these interventions can help promote better health outcomes for our patients.
The second case scenario presented depicts a 63-year-old white female presenting with a COPD
exacerbation. The patient presented to the hospital with worsening shortness of breath, increased
sputum production, and a hacking cough that won’t go away preventing her from sleeping at night. The
patient has a past medical history of COPD for 12 years, mild obesity, hypertension, osteopenia, and a
current smoker. Her history of COPD, current smoking, mild obesity, hypertension, and her diet of
canned and processed foods, soda drinking, and lack of exercise all have contributing factors to her
worsening COPD. On top of this, she does not have easy access to her primary care provider, lacks a
good support system, is financially unstable, and lives in a poor maintained building in a mostly
unwalkable community due to conditions of
Populations CPE - Hospital Readmissions Reduction Program: A
Case Study on COPD Western Governors University
The Hospital Readmissions Reduction Program is a program managed by the Centers for Medicare and
Medicaid services which aims to reduce unnecessary hospital readmissions. The program incentivizes
hospitals to provide high quality care during and after a patient’s stay by facing financial penalties if they
have excessive readmission rates within 30 days of discharge. The hospital is compared to national
benchmarks of readmission rates to ensure they are providing proper care coordination, patient
education, and post-discharge planning.
The program currently looks at numbers for acute myocardial infarctions, chronic obstructive
pulmonary disease, heart failure, pneumonia, coronary artery bypass grafts, and elective primary total
knee/hip arthroplasty. The advanced professional nurse is able to utilize this program to help promote
better health outcomes by identifying high risk patients early in their hospital stay, strengthen
interdisciplinary communication and care coordination which promotes more comprehensive care,
, improve transitional care and ensuring that patients understand their discharge instructions, and help
support health equity by recognizing the social determinants of health that often lead to readmissions.
All of these interventions can help promote better health outcomes for our patients.
The second case scenario presented depicts a 63-year-old white female presenting with a COPD
exacerbation. The patient presented to the hospital with worsening shortness of breath, increased
sputum production, and a hacking cough that won’t go away preventing her from sleeping at night. The
patient has a past medical history of COPD for 12 years, mild obesity, hypertension, osteopenia, and a
current smoker. Her history of COPD, current smoking, mild obesity, hypertension, and her diet of
canned and processed foods, soda drinking, and lack of exercise all have contributing factors to her
worsening COPD. On top of this, she does not have easy access to her primary care provider, lacks a
good support system, is financially unstable, and lives in a poor maintained building in a mostly
unwalkable community due to conditions of
