Cefuroxime is associated with Lower Hospital Readmission Rates for Chronic obstructive pulmonary disease (COPD) Patients at Enloe Medical Center based on Real World Evidence Study of Medicare Claims Data


In Cefuroxime, Chronic Obstructive Pulmonary Disease (COPD)

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By: Sara Riascos  Apr. 19, 2022

Background:

Chronic obstructive pulmonary disease (COPD) is frequently associated with hospital readmission. Readmission is a hospital quality measure that reflects dimensions of quality of inpatient care and also impacts overall programs by payors such as CMS’s Star Rating Program, HRRP and Value-Based Purchasing. Cefuroxime is an antibiotic used to treat bacterial infections of the ear, nose, throat, lungs, skin, bones, joints, bladder, or kidneys. Cefuroxime is the most commonly used antibiotic in the treatment of acute COPD exacerbation.

Dexur’s analysis of Real World Evidence based on Medicare Claims data showed that the use of Cefuroxime within 7 days of hospitalization was associated with lower hospital readmission rates for Chronic obstructive pulmonary disease (COPD) Patients at Enloe Medical Center in Chico, California. Reduction in readmission rates helps hospitals improve their outcomes for various cost and quality programs. Dexur is an approved entity to perform Medicare claims data analysis, which it uses to perform quality outcomes analysis. Dexur has published several papers with Harvard Medical School on quality outcomes related topics. Dexur’s analysis of Drugs and their impact on quality outcomes, such as readmissions and mortality, are used by Hospitals, IDNs, and ACOs to implement best practices and manage Real World Evidence based risk factors.

Methods:

We conducted a retrospective study using Dexur’s analysis of Real World Evidence from Medicare Claims data, for hospitalizations at Enloe Medical Center between January 2017 to September 2019. Our methodology criteria was as follows:

  1. Inclusion Criteria: Selected Medical Hospitalizations with Primary Diagnosis with Chronic obstructive pulmonary disease (COPD) related codes (Listed in table below)
  2. Stratified Selected population into cohorts
    1. Chronic obstructive pulmonary disease (COPD) patients who dispensed Cefuroxime within 7 Days of Hospitalization using Part D drugs claims database
    2. Chronic obstructive pulmonary disease (COPD) patients who did not dispense Cefuroxime within 7 Days of Hospitalization
  3. 30 Day readmission rates were analyzed for both population cohorts

Results:

Overall, Cefuroxime was associated with lower hospital readmission rates for all Primary ICD Diagnosis Codes examined at Enloe Medical Center. For patients whose primary DRG Diagnosis was “Chronic obstructive pulmonary disease with (acute) exacerbation”(J441) and when Cefuroxime was used within 7 days of hospitalization, the readmission rate was 16% compared to the cohort where Cefuroxime was not used, whose readmission rate was 23.48%. The readmission odds ratio for these cohorts was 62%. The use of Cefuroxime was associated with a 38% lower readmission rate when used within 7 days of hospitalization. The full list of studied ICD codes, readmission rates, odds ratios, confidence intervals, and percentage reduction in readmission with Cefuroxime at Enloe Medical Center is shown below.


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Primary ICD Diagnosis Code Primary ICD Diagnosis Code Description Total Hospitalizations without Cefuroxime Readmission Without Cefuroxime Readmission Rate without Cefuroxime Total Hospitalizations with Cefuroxime Readmission with Cefuroxime Readmission Rate with Cefuroxime Readmission Odds Ratio Reduction in Readmission with Cefuroxime (%) Confidence Interval (-) Confidence Intervals (+)
J441 Chronic obstructive pulmonary disease with (acute) exacerbation 1,022

Dexur also leveraged Medicare claims data to understand what percentage of patients hospitalized with Chronic obstructive pulmonary disease (COPD) were not prescribed Cefuroxime within 7 days of discharge.

ICD CODE Hospital Hospitalizations with Chronic obstructive pulmonary disease (COPD) % of Hospitalizations without Cefuroxime
J441 Enloe Medical Center 1,034 98.84%
Christiana Hospital 1,378 At Least 99.13%
Florida Hospital Orlando 1,371 At Least 99.12%

​Hospitalizations with Chronic obstructive pulmonary disease (COPD) = Above Listed ICD Codes

If figures are shared with “At Least” - this implies that the drug utilization within 7 days post hospitalization is less than 11

Conclusions:

According to analysis of Real World Evidence of Medicare Claims data, for hospitalizations between January 2017 to September 2019, the use of Cefuroxime within 7 days of hospitalization can lead to substantial reductions in hospital readmission rates of Chronic obstructive pulmonary disease (COPD) patients at Enloe Medical Center. This analysis shows that a significant number of Patients are not dispensed Cefuroxime after Chronic obstructive pulmonary disease (COPD) hospitalizations at Enloe Medical Center or major US Hospitals.