1. Centers for Disease Control and Prevention (CDC). National Center for Health Statistics. Deaths: Final data for 2009. Natl Vital Stat Rep. 2011; 60(03):1-117.
2. Agency for Healthcare Research and Quality. HCUPnet: Online query system based on data from the Healthcare Cost and Utilization Project. HCUPnet website. http://hcupnet.ahrq.gov. Accessed August 5 2014.
3. Jencks SF, Williams MV, Coleman EA. Rehospitalizations among patients in the medicare fee-for-service program. N Engl J Med. 2009;360:1418-1428. doi: http://dx.doi.org/10.1056/NEJMsa0803563
4. National Heart Lung and Blood Institute Fact Book, Fiscal Year 2012, Chapter 4-Disease statistics. National Heart Lung and Blood Institute website. http://www.nhlbi.nih.gov/about/factbook/chapter4.htm. Published 2012. Accessed August 5 2014.
5. Stein BD, Charbeneau JT, Lee TA, et al. Hospitalizations for acute exacerbations of chronic obstructive pulmonary disease: How you count matters. COPD. 2010;7:164-171. doi: http://dx.doi.org/10.3109/15412555.2010.481696
6. Medicare Payment Advisory Commission. Report to the Congress: Promoting Greater Efficiency in Medicare. Washington, DC: Medicare Payment Advisory Commission; 2007.
7. Toy EL, Gallagher KF, Stanley EL, Swensen AR, Duh MS. The economic impact of exacerbations of chronic obstructive pulmonary disease and exacerbation definition: a review. COPD. 2010; 7: 214–228. doi: http://dx.doi.org/10.3109/15412555.2010.481697
8. Lindenauer PK, Pekow P, Gao S, Crawford AS, Gutierrez B, Benjamin EM. Quality of care for patients hospitalized for acute exacerbations of chronic obstructive pulmonary disease. Ann Intern Med. 2006; 144:894–903. Doi: http://dx.doi.org/10.7326/0003-4819-144-12-200606200-00006
9. Boston University Medical Center, Boston University School of Medicine. Project Red (Re-Engineered Discharge)website. http://www.bu.edu/fammed/projectred/index.html. Published 2014. Accessed August 5, 2014.
10. Penn Nursing Science.Transitional Care Model website. http://www.transitionalcare.info/ . Accessed August 5, 2014.
11. School of Medicine Health Care Policy and Research, University of Colorado, Anschultz Medical Campus. The Care Transitions Program website. http://www.caretransitions.org/documents/Evidence_and_Adoptions_9_2014.pdf Accessed December 12, 2014
12. Project Boost mentored implementation program. Society of Hospital Medicine website. http://www.hospitalmedicine.org/boost/. Accessed August 5, 2014.
13. Mularski RA, McBurnie MA, Lindenauer PK, et al. CONCERT Investigator Consortium. Comparative effectiveness research in chronic obstructive pulmonary disease. J Comp Eff Res. 2012; 1:71-82. doi: http://dx.doi.org/10.2217/cer.11.10
14. Lindenauer PK, Grosso LM, Wang C, et al. Development, validation, and results of a risk-standardized measure of hospital 30-day mortality for patients with exacerbation of chronic obstructive pulmonary disease. J Hosp Med. 2013; 8:428-35. doi: http://dx.doi.org/10.1002/jhm.2066
15. Mularski RA, Asch SM, Shrank WH, et al. The quality of obstructive lung disease care for adults in the United States as measured by adherence to recommended processes. Chest. 2006; 130: 1844-1850. doi: http://dx.doi.org/10.1378/chest.130.6.1844
16. Elixhauser A, Au DH, Podulka J. Readmissions for Chronic Obstructive Pulmonary Disease, 2008: Statistical Brief #121. In: Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Rockville, MD: Agency for Health Care Policy and Research; 2006. http://www.ncbi.nlm.nih.gov/books/NBK65392/. Accessed August 5, 2014
17. Hurst JR, Vestbo J, Anzueto A, et al. Susceptibility to exacerbation in chronic obstructive pulmonary disease. N Eng J Med. 2010; 363:1128-38. doi: http://dx.doi.org/10.1056/NEJMoa0909883
18. Barr RG, Celli BR, Mannino DM, et al. Comorbidities, patient knowledge and disease management in a national sample of patients with chronic obstructive pulmonary disease. Am J Med. 2009; 122(4):348-355. doi: http://dx.doi.org/10.1016/j.amjmed.2008.09.042
19. Schnell KM, Weiss CO, Lee TA, et al. The prevalence of clinically-relevant comorbid conditions in patients with COPD: a cross-sectional study using data from NHANES 1999-2008. BMC Pulm Med. 2012; 12:26. doi: http://dx.doi.org/10.1186/1471-2466-12-26
20. Baker CL, Zou KH, Su J. Risk assessment of readmissions following an initial COPD-related hospitalization. Int J Chron Obstruct Pulmon Dis. 2013; 2013:551–559.
21. Charlson M, Charlson RE, Briggs W, Hollenberg J. Can disease management target patients most likely to generate high costs? The impact of comorbidity. J Gen Intern Med. 2007; 22(4):464-469. doi: http://dx.doi.org/10.1007/s11606-007-0130-7
22. Divo M, Cote C, Casanova C, et al. Comorbidities and risk of mortality in patients with COPD. Am J Resp Crit Care Med. 2012; 186(2):155–161. doi: http://dx.doi.org/10.1164/rccm.201201-0034OC
23. Budweiser S, Harlacher M, Pfeifer M. Jorres RA. Co-morbidities and hyperinflation are independent risk factors of all-cause mortality in very severe COPD. COPD. 2014; 11(4):388-400. doi: http://dx.doi.org/10.3109/15412555.2013.836174
24. Mannino DM, Buist AS, Petty TL, Enright PL, Redd SC. Lung function and mortality in the United States: data from the first National Health and Nutrition Examination Study follow-up study. Thorax. 2003; 58:388-393. doi: http://dx.doi.org/10.1136/thorax.58.5.388
25. Krumholz HM. Post-hospital syndrome: An acquired, transient condition of generalized risk. N Engl J Med. 2013; 368:100-102. doi: http://dx.doi.org/10.1056/NEJMp1212324
26. Spencer S, Karner C, Cates CJ, Evans DJ. Inhaled corticosteroids versus long-acting beta 2-agonists for chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2011, (12). doi: http://dx.doi.org/10.1002/14651858.CD007033.pub3
27. Vincken W, van Noord JA, Greefhorst AP, et al for the Dutch/Belgian Tiotropium Study Group. Improved health outcomes in patients with COPD during 1 yr's treatment with tiotropium. Eur Respir J. 2002; 19:209–16. doi: http://dx.doi.org/10.1183/09031936.02.00238702
28. Poole PJ, Black PN. Mucolytic agents for chronic bronchitis or chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2006;(3).
29. Seemungal T, Wilkinson TMA, Hurst JR, Perera W, Sapsford RJ, Wedzicha JA. Long term macrolide therapy is associated with decreased COPD exacerbation frequency. Am J Respir Crit Care Med. 2008; 178(11):1139–1147. doi: http://dx.doi.org/10.1164/rccm.200801-145OC
30. Melani AS, Bonavia M, Cilenti V, et al. Inhaler mishandling remains common in real life and is associated with reduced disease control. Respir Med. 2011;105(6):930–938. doi: http://dx.doi.org/10.1016/j.rmed.2011.01.005
31. Press VG, Arora VM, Shah LM, et al. Misuse of respiratory inhalers in hospitalized patients with asthma or COPD. J Gen Intern Med. 2011; 26(6):635-642. doi: http://dx.doi.org/10.1007/s11606-010-1624-2
32. Yawn BP, Colice GL, Hodder R. Practical aspects of inhaler use in the management of chronic obstructive pulmonary disease in the primary care setting. Int J Chron Obstruct Pulmon Dis. 2012; 2012:495-502. doi: http://dx.doi.org/10.2147/COPD.S32674
33. Neri M, Melani AS, Miorelli AM, et al. Long-term oxygen therapy in chronic respiratory failure: a Multicenter Italian Study on Oxygen Therapy Adherence (MISOTA). Respir Med. 2006; 100(5):795-806. doi: http://dx.doi.org/10.1016/j.rmed.2005.09.018
34. Robinson T. Living with severe hypoxic COPD: the patients' experience. Nurs Times. 2005; 101(7):38-42.
35. Crockett AJ, Cranston JM, Moss JR, Alpers JH. Effects of long-term oxygen therapy on quality of life and survival in chronic airflow limitation. Monaldi Arch Chest Dis. 1999; 54:193-196.
36. Block AJ, Castle JR, Keitt AS. Chronic oxygen therapy. Treatment of chronic obstructive pulmonary disease at sea level. Chest. 1974; 65(3):279-288. doi: http://dx.doi.org/10.1378/chest.65.3.279
37. Leggett RJ, Flenley DC. Portable oxygen and exercise tolerance in patients with chronic hypoxic cor pulmonale. Br Med J. 1977, 2:84-86. doi: http://dx.doi.org/10.1136/bmj.2.6079.84
38. Desveaux L, Ferreira TJ, Goldstein R, Brooks D. An international comparison of pulmonary rehabilitation: a systematic review. COPD. 2014. [Epub ahead of print]. doi: http://dx.doi.org/10.3109/15412555.2014.922066
39. Suh ES, Mandal S, Hart N. Admission prevention in COPD: non-pharmacological management. BMC Med. 2013;11:247. doi: http://dx.doi.org/10.1186/1741-7015-11-247
40., Schauer GL, Wheaton AG, Malarcher AM, Croft JB. Smoking prevalence and cessation characteristics among U.S. adults with and without COPD: Findings from the 2011 Behavioral Risk Factor Surveillance System. COPD. 2014; 11(6):697-704. doi: http://dx.doi.org/10.3109/15412555.2014.898049
41. Anthonisen NR, Connett JE, Enright PL, Manfreda J. Hospitalizations and mortality in the lung health study. Am J Respir Crit Care Med. 2002; 166(3):333-339. doi: http://dx.doi.org/10.1164/rccm.2110093
42. Kessler R, Faller M, Fourgaut G, Mennecier B, Weitzenblum E. Predictive factors of hospitalization for acute exacerbation in a series of 64 patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1999; 159(1):158-164. doi: http://dx.doi.org/10.1164/ajrccm.159.1.9803117
43. Godtfredsen NS, Vestbo J, Osler M, Prescott E. Risk of hospital admission for COPD following smoking cessation and reduction: a Danish population study. Thorax. 2002; 57:967-972. doi: http://dx.doi.org/10.1136/thorax.57.11.967
44. Au DH, Bryson CL, Chien JW, et al. The effects of smoking cessation on the risk of chronic obstructive pulmonary disease exacerbations. J Gen Intern Med. 2009; 24(4):457-463. doi: http://dx.doi.org/10.1007/s11606-009-0907-y
45. Schembri S, Anderson W, Morant S, et al. A predictive model of hospitalisation and death from chronic obstructive pulmonary disease. Respir Med. 2009; 103(10):1461-1467. doi: http://dx.doi.org/10.1016/j.rmed.2009.04.021
46. Schembri S, Morant S, Winter JH, MacDonald TM. Influenza but not pneumococcal vaccination protects against all-cause mortality in patients with COPD. Thorax. 2009; 64:567-72. doi: http://dx.doi.org/10.1136/thx.2008.106286
47. Plans-Rubió P. Prevention and control of influenza in persons with chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis. 2007; 2:41-53. doi: http://dx.doi.org/10.2147/copd.2007.2.1.41
48. Kangovi S, Grande D. Hospital readmissions--not just a measure of quality. JAMA. 2011; 306 (16):1796-1797. doi: http://dx.doi.org/10.1001/jama.2011.1562
49. Calvillo-King L, Arnold D, Eubank KJ, et al. Impact of social factors on risk of readmission or mortality in pneumonia and heart failure: Systematic review. J Gen Intern Med. 2013; 28(2):269-282. doi: http://dx.doi.org/10.1007/s11606-012-2235-x
50. Prieto-Centurion V, Gussin HA, Rolle AJ, Krishnan JA. Chronic obstructive pulmonary disease readmissions at minority-serving institutions. Ann Am Thorac Soc. 2013; 10(6):680-684. doi: http://dx.doi.org/10.1513/AnnalsATS.201307-223OT
51. Readmissions reduction program. Centers for Medicare and Medicaid Services website. http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/Readmissions-Reduction-Program.html. Updated August 2014. Accessed August 5, 2014]
52. Feemster LC, Au DH. Penalizing hospitals for chronic obstructive pulmonary disease readmissions. Am J Resp Crit Care Med. 2014; 189 (6): 634-639. doi: http://dx.doi.org/10.1164/rccm.201308-1541PP
53. Kangovi S, Grande D. Transitional care management reimbursement to reduce COPD readmission. Chest. 2014; 145(1):149–155. doi: http://dx.doi.org/10.1378/chest.13-0787
54. Stein BD, Bautista A, Schumock GT, et al. The validity of International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes for identifying patients hospitalized for COPD exacerbations. Chest. 2012; 141(1):87-93. doi: http://dx.doi.org/10.1378/chest.11-0024
55. Hansen LO, Young RS, Hinami K, Leung A, Williams MV. Interventions to reduce 30-day rehospitalization: A systematic review. Ann Intern Med. 2011; 155(8):520-528. doi: http://dx.doi.org/10.7326/0003-4819-155-8-201110180-00008
56. Jack BW, Chetty VK, Anthony D, et al. A reengineered hospital discharge program to decrease rehospitalization: a randomized trial. Ann Intern Med. 2009; 150(3):178-87. doi: http://dx.doi.org/10.7326/0003-4819-150-3-200902030-00007
57. Coleman EA, Parry C, Chalmers S, Min SJ. The Care Transitions Intervention. Results of a randomized controlled trial. Arch Intern Med. 2006; 166(17): 1822-28. doi: http://dx.doi.org/10.1001/archinte.166.17.1822
58. Coleman EA, Smith JD, Frank JC, Min S, Parry C, Kramer AM. Preparing patients and caregivers to participate in care delivered across settings: the care transitions intervention. J Am Geriatr Soc. 2004; 52(11):1817-1825. doi: http://dx.doi.org/10.1111/j.1532-5415.2004.52504.x
59. Parry C, Kramer H, Coleman EA. A qualitative exploration of a patient-centered coaching intervention to improve care transitions in chronically ill older adults. Home Health Care Serv Q. 2006; 25(3-4):39-53. doi: http://dx.doi.org/10.1300/J027v25n03_03
60. Naylor MD, Brooten D, Campbell R, et al. Comprehensive discharge planning and home follow-up of hospitalized elders: a randomized clinical trial. JAMA. 1999; 281(7):613-620. doi: http://dx.doi.org/10.1001/jama.281.7.613
61. Naylor MD, Brooten DA, Campbell RL, Maislin G, McCauley KM, Schwartz JS. Transitional care of older adults hospitalized with heart failure: a randomized, controlled trial. J Am Geriatr Soc. 2004; 52(5):675-684. doi: http://dx.doi.org/10.1111/j.1532-5415.2004.52202.x
62. Maynard G, Budnitz T, Nickel WK, et al. Mentored implementation: a collaborative improvement model for breakthrough achievement. Jt. Comm J Qual Saf. 2012; 38:301-10.
63. Coleman EA, Williams MV. Executing high-quality care transitions: a call to do it right. J Hosp Med. 2007; 2(5):287-290. doi: http://dx.doi.org/10.1002/jhm.276
64. Williams MV, Coleman EA. BOOSTing the hospital discharge. J Hosp Med. 2009; 4(4):209-210. doi: http://dx.doi.org/10.1002/jhm.525
65. Hansen LO, Greenwald JL, Budnitz T, et al. Project BOOST: Effectiveness of a multihospital effort to reduce rehospitalization. J Hosp Med. 2013; 8(8):421–427. doi: http://dx.doi.org/10.1002/jhm.2054
66. Markley J, Andow V, Sabharwal K, Wang Z, Fennell E, Dusek R. A project to reengineer discharges reduces 30-day readmission rates. Am J Nurs. 2013; 113(7):55-64. doi: http://dx.doi.org/10.1097/01.NAJ.0000431922.47547.eb
67. Naylor M, Brooten D, Jones R, Lavizzo-Mourey R, Mezey M, Pauly M. Comprehensive discharge planning for the hospitalized elderly: a randomized clinical trial. Ann Intern Med. 1994; 120(12):999–1006. doi: http://dx.doi.org/10.7326/0003-4819-120-12-199406150-00005
68. Naylor MD, Hirschman KB, Hanlon AL, et al. Comparison of evidence-based interventions on outcomes of hospitalized, cognitively impaired older adults. J Comp Eff Res. 2014; 3(3):245-257. doi: http://dx.doi.org/10.2217/cer.14.14
69. Parry C, Coleman EA, Smith JD, Frank JC, Kramer AM. The Care Transitions Intervention: A patient-centered approach to facilitating effective transfers between sites of geriatric care. Home Health Serv Q. 2003; 22(3):1-18. doi: http://dx.doi.org/10.1300/J027v22n03_01
70. Prieto-Centurion V, Markos MA, Ramey NI, et al. Interventions to reduce rehospitalizations following COPD exacerbations: a systematic review. Ann Am Thorac Soc. 2014; 11(3):417-424. doi: http://dx.doi.org/10.1513/AnnalsATS.201308-254OC
71. Fan VS, Gaziano JM, Lew R, et al. A comprehensive care management program to prevent chronic obstructive pulmonary disease hospitalizations: A randomized, controlled trial. Ann Intern Med. 2012; 156(10):673-683. doi: http://dx.doi.org/10.7326/0003-4819-156-10-201205150-00003
72. Casas A, Troosters T, Garcia-Aymerich J, et al. Integrated care prevents hospitalisations for exacerbations in COPD patients. Eur Resp J. 2006; 28(1):123-130. doi: http://dx.doi.org/10.1183/09031936.06.00063205
73. Kwok T, Lum CM, Chan HS, Ma HM, Lee D, Woo J. A randomized, controlled trial of an intensive community nurse-supported discharge program in preventing hospital readmissions of older patients with chronic lung disease. J Am Geriatr Soc. 2004; 52(8):1240-1246. doi: http://dx.doi.org/10.1111/j.1532-5415.2004.52351.x
74. Bourbeau J, Julien M, Maltais F, et al. Reduction of hospital utilization in patients with chronic obstructive pulmonary disease: A disease-specific self-management intervention. Arch Intern Med. 2003; 163(5):585-591. doi: http://dx.doi.org/10.1001/archinte.163.5.585
75. Bucknall CE, Miller G, Lloyd SM, et al. Glasgow supported self-management trial (GSuST) for patients with moderate to severe COPD: Randomised controlled trial. Br Med J. 2012;344:e1060. doi: http://dx.doi.org/10.1136/bmj.e1060
76. Kanel KT, Elster S, Vrbin C. PRHI readmission brief: chronic obstructive pulmonary disease. Pittsburgh Regional Health Initiative website. http://www.prhi.org/images/stories/docs/PRHI%20COPD%20Readmission%20Brief%20Dec%202011.pdf. Accessed August 5, 2014.