The Impact of a Home Respiratory Therapist to Reduce 30-Day Readmission Rates for Exacerbation of COPD

被引：9

作者：

Truumees, Monica ^{[1
]}

Kendra, Moira ^{[2
]}

Tonzola, Danielle ^{[3
]}

Chiu, Stephanie ^{[4
]}

Cerrone, Federico ^{[5
]}

Zimmerman, Debra ^{[6
]}

Mackwell, Cristen ^{[7
]}

Stevens, Catherine ^{[8
]}

Scannell, Katelyn ^{[9
]}

Daley, Brittney ^{[3
]}

Markley, Daniel ^{[10
]}

Shah, Chirag, V ^{[10
]}

Mansukhani, Rupal ^{[3
,11
]}

机构：

[1] Atlantic Hlth Syst Home Med, Morris Plains, NJ USA

[2] Atlantic Hlth Syst, Morris Plains, NJ USA

[3] Morristown Med Ctr, Morristown, NJ 07960 USA

[4] Atlantic Hlth Ctr Res, Morristown, NJ USA

[5] Pulm & Allergy Associates, Atlantic Med Grp, Summit, NJ USA

[6] Newton Med Ctr, Newton, NJ USA

[7] Hackettstown Med Ctr, Hackettstown, NJ USA

[8] Chilton Med Ctr, Pompton Plains, NJ USA

[9] Overlook Med Ctr, Summit, NJ USA

[10] Pulm & Allergy Associates, Atlantic Med Grp, Cedar Knolls, NJ USA

[11] Rutgers State Univ, Piscataway, NJ USA

来源：

RESPIRATORY CARE | 2022年 / 67卷 / 06期

关键词：

respiratory therapy; COPD; hospital readmission; home care agency; Centers for Medicare and Medicaid Services; patient education; patient centered care; home visit program; adherence; home care program; HOSPITAL READMISSIONS; CARE;

D O I：

10.4187/respcare.08125

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

BACKGROUND: In 2015, the Centers for Medicare and Medicaid Services limited payments to hospitals with high readmission rates for patients admitted with COPD exacerbation. Decreasing readmissions in this patient population improves patient health and decreases health care utilization of resources. We hypothesized a COPD disease management program delivered by a respiratory therapist (RT) in the patient's home may reduce readmission rates for COPD exacerbation. METHODS: We performed a pre/post interventional study comparing hospital readmissions for subjects with COPD exacerbation that received standard of care in the home versus an RT-led home COPD disease management program. Subjects discharged home from Atlantic Health System with COPD exacerbation were enrolled in the pre-intervention group. Subsequently, an evidence-based home COPD disease management program was implemented by an RT from At Home Medical in the home. The home COPD Disease Management Program was implemented from April 2017-September 2019, and this served as the post-intervention group. The primary end point was readmission rates at 30 d. Secondary end points included 60-d and 90-d readmission rates. RESULTS: A total of 1,093 participants were included in the study, 658 in the pre-intervention cohort and 435 participants in the post-intervention group. Approximately 22.3% (n = 147) of subjects in the pre-intervention group was readmitted within 30 d of discharge compared to 12.2% (n 5 53) in the post-intervention group (P<.001). A reduction in 60-d (33.9% vs 12.0%, P<.001) and 90-d all-cause readmissions (43.5% vs 13.1%, P<.001) was also seen. Participation in the COPD Disease Management Program was significantly associated with decreased 30-, 60-, and 90-d readmission rates adjusting for age, gender, race, ethnicity, and smoking status (odds ratio 0.48 [95% CI 0.33-0.70]; odds ratio 0.26 [95% CI 0.18-0.38]; odds ratio 0.20 [95% CI 0.14-0.27];P<.001, for all 3 readmission rates). CONCLUSIONS: The COPD Disease Management Program is significantly associated with decreased readmission adjusting for demographics and smoking status. [(C) 2022 Daedalus Enterprises]

引用

页码：631 / 637

页数：7