How PCP-Ordered Home RTs Slashed Readmissions and ER Visits

In a field plagued by COPD readmission rates, registered respiratory therapist (RRT) Kimberly Palczynski had a hunch that working more closely with primary care physicians might help stem the tide. But she never could have expected just how big of an impact an RT-driven, patient home care program in conjunction with PCPs would actually have.

Hear from Palczynski as she explains how bringing primary care physicians into the picture helped dramatically reduce COPD readmissions and ER visits at her institution.

Well, we started the program. It’s an RT home-based respiratory therapist program, and it stemmed from our relationship with our physician groups in our system so what they decided was, we see our readmissions for COPD patients climbing and climbing, so what are we going to do about it?

We worked with our respiratory therapist that’s from pulmonary rehab, and we got together with our – it’s called signature partner. What we did is we looked at a focus group of COPD patients. And in the first year that we had the program, we looked at 63 patients, and we followed them for a year. And at the end of the year, we collected the data, based on their visit from the respiratory therapist.

So what they do is they go in and the respiratory therapist goes into the home and looks at their environment, and looks at their family support, and looks at their DME, their durable medical equipment. Do they have what they need? Does the equipment work? Do they have the medication that they need? Do they know how to use it? Do they know what it’s for?

They put all those pieces together, and then what they do is they take it back to the primary care physician and say, “We’ve identified these needs. We know what works for them. This is what they’re doing that’s right, but over here – OK, let’s see what they need to do – what work they need to do.” 

They put all those pieces together, and then what they do is they take it back to the primary care physician and say, “We’ve identified these needs. We know what works for them. This is what they’re doing that’s right, but over here—OK, let’s see what they need to do—what work they need to do.” 

And have they been to see their primary care physician in a while? We look at that. Have they had a pulmonary function test? Do they need a sleep study? We take that skill set of the respiratory therapist, and we look at those patients, and we identify their needs.

And we found that a year later, the COPD patients were less likely to be readmitted by 70%, with just one home visit. They were 82% less likely to go back to the emergency room. So, big changes.

And it’s more than that. It’s the daily life of these patients. It’s the quality of life. How can we better address those things that they need to do? Education goes so far, but how does it impact them every day? Do they want to go see family? A lot of our patients say, “I wanted to go on a trip, but I couldn’t, because I can’t breathe.” So that intervention from the respiratory therapist in partnership with the primary care physician is priceless.

When we were starting this program, obviously cost was a big issue.

So there is a little pushback on, “OK, is it worth it to us to invest – to include these patients in this bundle?”

When you look at the readmission rates and the cost of readmission, we can prove that case by saying, “Look, we can reduce readmissions by 70%. We’ve proven it in the first year. Reduced readmission for emergency room, 82%.” 

That in and of itself was proof.

Kimberly Palczynski, RRT, RT
COPD Navigator
Inova Health

This article was republished with permission from Philips Respironics. It originally appeared in their COPD Insider online publication.