Preventing hospital readmissions among patients with COPD. Here are some ideas on how to do that | CHEST 2026

Hospital readmission is a common occurrence for patients with chronic obstructive pulmonary disorder (COPD) that patients and the people who take care of them would like to avoid if at all possible.

Research presented at last year’s CHEST meeting showed that the 30-day readmission rate was 18%. Patients who were readmitted experienced respiratory failure with hypoxia, sepsis, heart failure, and pneumonia, and the average length of stay was two days longer than the initial admission. A meta-analysis published earlier this year in Frontiers in Medicine showed a wide variability in readmission rates among 27 studies, ranging from 3.5% to 50%. Factors associated with readmission included male sex, elevated C-reactive protein and red cell distribution width and having other health conditions (higher Charlson Comorbidity Index).

It is not surprising, then, that clinicians, patients, payers and insurers all have a stake in reducing COPD readmission. An artificial intelligence-assisted search of the abstracts presented at the 2026 CHEST meeting identified two abstracts summarizing research into hospital readmissions among patients with COPD and a third on emergency room (ER) visits. Together they suggest that clinicians and other providers can take steps to prevent readmissions and emergency room visits that keep patients out of the hospital and the ER.

Reyleen Loreto, M.D., a resident at St. Joseph’s Hospital in Tampa Bay, Florida, and her colleagues found that a quality improvement program that included a standardized COPD discharge checklist and care navigation consultation reduced 30-day readmission rates from 27.9% to 18.3%. A second study found that the chances of hospital readmission were markedly higher among patients with COPD who were discharged to a post-acute care facility. The third study, conducted by Valarie G. Press, M.D., M.P.H., a professor of medicine at the University of Chicago and director of the COPD Transitions of Care Program, found wide variability in emergency room revisits among the 20 hospitals participating in the Reduce REVISITS trial, which Press is leading.

In their abstract, Loreto and her colleagues described conducting a prospective quality improvement initiative using the plan-do-study-act methodology, a systematic way of introducing changes in relatively small steps and then evaluating the results before wider implementation. The changes they introduced between July 2025 and February 2026 included a COPD discharge checklist, structured inhaler education with documentation, care navigator consultation for follow-up scheduling, increased use of a COPD electronic order set, and standardized pulmonary rehabilitation referral.

Modifiable contributors to COPD readmissions

Among 135 COPD discharges, the 30-day readmission rate, which was the primary outcome, decreased from 27.9% before implementation to 18.2% after implementation. Loreto and her colleagues also found improvements in checklist compliance (91% to 97%), navigator consultation (44% to 95%), order set utilization (72% to 82%), and pulmonary rehabilitation referral (24% to 45%). Readmissions were lower among patients with navigator consultation and those with scheduled follow-up appointments.

“The observed improvement suggests that variability in discharge workflows and follow-up coordination represents a modifiable contributor to preventable COPD readmissions,” the researchers wrote in the conclusion, noting that patients with navigator consultation have markedly lower readmission rates (20% vs 35%). They added, “These findings demonstrate that standardization of discharge processes improves COPD care transitions and reduces hospital utilization” and that ongoing plan-do-study-act cycles will evaluate long-term sustainability and inform broader institutional implementation.

The second abstract reports on a retrospective look at 670 people with COPD who were admitted at a large urban medical center that is not named. The brief report that is short on details says that readmissions were 70% to 90% higher among those discharged to post-acute care facilities. The authors don’t seem to be suggesting a causal inference but rather that care might be managed in a way that lowers readmissions when patients with COPD are discharged to a post-acute care facility.

“Hospital-to-facility COPD pathways emphasizing communication, guideline-directed therapy optimization and early follow-up may improve outcomes while reducing healthcare utilization,” wrote the authors.

Press and her colleagues thumbnail the Reduce REVISITS trial as a randomized trial of a one-year implementation of a COPD transitions of care program. This analysis of the data collected during the trial included 6,323 patients hospitalized for COPD. Approximately half of patients were women, and the average age was 67.

Regional differences in ER visits by patients with COPD

In this study, they set out to examine regional differences — Midwest, South, Northeast and West. Each of the regions had at least one large and medium-sized hospital, two urban hospitals, and two academic hospitals.

When adjusting for patient-level characteristics, Press and her colleagues found the odds of a COPD 30-day revisit to an ER among Black patients compared with White patients at sites in the Midwest region were 51% higher. In the Northeast they were 282% higher; in the South, 282% higher; and in the West, the same. When adjusting for hospital-level characteristics, the researchers found the odds of a COPD 30-day revisit to an ER among medium hospitals within the Midwest region were 154% higher. The abstract doesn’t mention other hospital differences in other regions.

Press and her colleagues said this preliminary analysis suggests regional variation in the effectiveness of COPD transition of care efforts and advised health systems to be on the lookout for shortcomings in those efforts that might not be immediately apparent. “Health systems should consider regional context, hospital characteristics, and patient demographics when implementing COPD TOC [transition of care] interventions to improve outcomes and reduce disparities in 30-day revisits,” they wrote.