Background:

Pulmonary Disease 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 payers such as CMS’s Star Rating Program, HRRP and Value-Based Purchasing. Ventolin HFA (Albuterol) is an Inhaled beta-2-agonist. Studies have shown the use of Ventolin (Albuterol) had an improvement in Pulmonary disease compared to the baseline. Other studies have shown the use of Ventolin (Albuterol) is safe for patients older than 4. Dexur’s analysis of Real-World Evidence based on Medicare Claims data showed that the use of Ventolin (Albuterol) within 7 days of hospitalization was associated with lower hospital readmission rates for Pulmonary Disease Patients. 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 between January 2019 to September 2019. Our methodology criteria was as follows:

1. Inclusion Criteria: Selected Medical Hospitalizations with Primary Diagnosis with Pulmonary Disease related codes (Listed in table below)

2. Stratified Selected population into cohorts

   1. Pulmonary Disease patients who dispensed Ventolin (Albuterol) within 7 Days of Hospitalization using Part D drugs claims database

   2. Pulmonary Disease patients who did not dispense Ventolin (Albuterol) within 7 Days of Hospitalization

3. 30 Day readmission rates were analyzed for both population cohorts

Results:

Overall, Ventolin (Albuterol) was associated with lower hospital readmission rates for all Primary ICD Diagnosis Codes examined. For patients whose primary ICD Diagnosis was “Chronic obstructive pulmonary disease with (acute) exacerbation” (J441) and when Ventolin (Albuterol) was used within 7 days of hospitalization, the readmission rate was 21.85% compared to the cohort where Ventolin (Albuterol) was not used, whose readmission rate was 24.18%. The readmission odds ratio for these cohorts was 0.88. The use of Ventolin (Albuterol) was associated with a 12% 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 Ventolin (Albuterol) is shown below.

Primary ICD Diagnosis Code	Primary ICD Diagnosis Code Description	Total Hospitalizations without Ventolin	Readmission without Ventolin	Readmission Rate without Ventolin	Total Hospitalizations with Ventolin	Readmission with Ventolin	Readmission Rate with Ventolin	Readmission Odds Ratio	Reduction in Readmission with Ventolin (%)	Confidence Interval (-)	Confidence Intervals (+)
J441	Chronic obstructive pulmonary disease with (acute) exacerbation	139,856	33,823	24.18%	7,465	1631	21.85%	0.88	12%	-2.45%	-2.22%
J189	Pneumonia, unspecified organism
J9621	Acute and chronic respiratory failure with hypoxia
J690	Pneumonitis due to inhalation of food and vomit
J9601	Acute respiratory failure with hypoxia
J181	Lobar pneumonia,unspecified organism
J440	Chronic obstructive pulmonary disease with acute lower respiratory infection
J9622	Acute and chronic respiratory failure with hypercapnia
J209	Acute bronchitis,unspecified

Dexur also leveraged Medicare claims data to understand what percentage of patients hospitalized with Pulmonary Disease at major Hospitals were not prescribed Ventolin within 7 days of discharge.

Conclusions:

According to analysis of Real-World Evidence of Medicare Claims data, for hospitalizations between January 2019 to September 2019, the use of Ventolin (Albuterol) within 7 days of hospitalization can lead to substantial reductions in hospital readmission rates of Pulmonary Disease patients. This analysis shows that a significant number of Patients are not dispensed Ventolin(Albuterol) after Pulmonary Disease hospitalizations at major US Hospitals.