By Staff Writer at the American Association for Respiratory Care (AARC)
An evidence-based at-home Chronic Obstructive Pulmonary Disease Management Program (COPD-MP) that is administered by a respiratory therapist significantly reduced COPD readmissions, according to a study published in the American Association for Respiratory Care’s (AARC) official science journal, Respiratory Care.
A chronic lung disease affecting some 15 million Americans, called chronic obstructive pulmonary disease (COPD), causes acute exacerbations that often require hospitalization. According to the study, these hospitalizations account for about $13.2 billion of the nearly $50 billion direct annual costs related to the condition.
Unfortunately, many people who are hospitalized with a COPD exacerbation end up back in the hospital within days or months of discharge. Statistics suggest that about 60% of patients return within a year after discharge, and 30% return within three months.
To curb these readmissions, the Centers for Medicare and Medicaid Services has included COPD in the Hospital Readmissions Reduction Program, which encourages hospitals to find ways to keep patients with selected diagnoses from returning soon after a discharge by cutting back payments for these patients.
The Respiratory Care study was carried out by New Jersey investigators and involved 1,093 patients in the Atlantic Health System, 658 in the pre-intervention cohort and 435 in the post-intervention cohort.
Intervention group patients received home visits from a respiratory therapist. These visits centered around reviewing pulmonary medication safety, creating a personalized COPD action plan, delivering smoking cessation services, referring patients to pulmonary rehabilitation and ensuring appropriate follow-up.
The respiratory therapist worked closely with the patient’s pulmonologist to overcome any barriers that might prevent the patient from managing their COPD at home. Most patients received three home visits from the respiratory therapist over a four-week period, but they could qualify for additional visits if those visits were deemed necessary.
The visits took place in a timely manner as well, with the therapist first visiting the patient at home within two days of discharge.
The intervention was based on previous studies showing that health coaching and education provided by a health care professional in a patient’s own home can identify barriers to optimal management and improve adherence to prescribed treatments and therapies. Taking a patient- and family-centered approach is key to effectively delivering these preventative services.
The authors of this study emphasized that their program was designed to meet these objectives and more.
“The improvements in communication included effective pulmonary guidance in the home after discharge, confirmation of early outpatient follow-up within seven days of discharge, increased patient and family engagement with the pulmonary discharge plans and assessment of the affordability of inhaler therapies,” the study reported.
Readmissions cut nearly in half
At 30 days after discharge, readmissions were at 22.3% in the pre-intervention group, versus 12.2% in the post-intervention group. Similar results were seen in 60-day readmissions, and 90-day all-cause readmissions as well, with readmissions in the pre- and post-intervention groups coming in at 33.9% versus 12% and 43.5% versus 13.1%, respectively.
This translates to a 10.1% absolute reduction in 30-day readmissions, a 21.9% reduction in 60-day readmissions and a 30.7% reduction in 90-day readmissions.
The findings held true even after they were adjusted to consider age, gender, race, ethnicity and smoking status. Researchers believe respiratory therapists are right for the home disease management role.
“It requires a complete understanding of respiratory therapy to facilitate a smooth transition between care in the hospital to that of managing a patient who is recovering from COPD exacerbation in the home,” the study wrote. “The RT can help patients with home health goals, such as improving symptom management and mitigating total health care expenditures by reducing acute care hospital readmissions.”
Researchers acknowledge that while some COPD readmissions cannot be avoided due to the progression of the disease, many of them are simply the result of poor coordination between the hospital and at-home care.
They believe that a COPD-MP using respiratory therapists to provide care and education at home can help improve coordination and keep patients from returning to the hospital so soon after discharge.
“This home health strategy was cost-effective for payers and not cost-prohibitive for our health care system, which contributed significantly to the success in reducing COPD hospital readmissions,” concluded the investigators. “Intervention at home can be easily incorporated into hospital discharge plans, while simultaneously not being overbearing for patients, families or providers.”
For additional information on this study, please read the full paper here.
Source: This article was written exclusively for RTSleepWorld