Rationale: Asthma poses a significant burden for US patients and health systems, yet inpatient care quality is understudied. National chronic obstructive lung disease (COPD) readmission policies may affect inpatient asthma care through hospital responses to these polices due to imprecise diagnosis and identification of patients with COPD and asthma.
Objectives: Evaluate inpatient care quality care for patients hospitalized with asthma and potential collateral effects of the Medicare COPD Hospital Readmissions Reduction Program (HRRP).
Methods: Retrospective cohort study of patients aged 18-54 years hospitalized for asthma across 924 US hospitals (Premier Healthcare Database).
Results: Care quality for patients with asthma was evaluated pre-HRRP implementation (n=20,820; January 2010-September 2014) and post-HRRP implementation (n=26,885; October 2014-December 2018) using adherence to inpatient care guidelines (recommended, non-recommended, and "ideal care" [all recommended with no non-recommended care]). Between 2010-2018, at least 80% of patients received recommended care annually. Recommended care decreased similarly (rate of 0.02%/month) post vs. pre-HRRP (p=0.8). Non-recommended care decreased more rapidly post-HRRP (rate of 0.29%/month) vs. pre-HRRP (rate of 0.17%/month; p<0.001) with changes driven largely by decreased antibiotic prescribing. Ideal care increased more rapidly post-HRRP (rate of 0.25%/month) vs. pre-HRRP (rate of 0.17%/month; p=0.02) with changes driven largely by non-recommended care improvements.
Conclusions: Post-HRRP trends suggest asthma care improved with increased rates of guideline concordance in non-recommended and ideal care. While federal policies (e.g., HRRP) may have had positive collateral effects such as with asthma care, parallel care efforts including antibiotic stewardship likely contributed to these improvements.