At-Home Interventions Significantly Cut Readmission Rates in COPD, Study Finds

A new study suggests at-home interventions by a respiratory therapist can reduce hospital readmission rates among patients with chronic obstructive pulmonary disease (COPD).

The intervention led to lower all-cause readmissions at 30, 60, and 90 days among a cohort of more than 400 patients across a New Jersey health care system. The study was published in Respiratory Care.

Corresponding author Rupal Mansukhani, PharmD, of Morristown Medical Center, noted that COPD readmissions have been targeted by CMS, which in 2015 began penalizing hospitals with high rates of readmission among patients treated for COPD exacerbations.

Mansukhani and colleagues noted that about 19% of people in the United States who are hospitalized with COPD will be readmitted within 30 days, and COPD is the third most common cause of hospital readmission among patients receiving Medicare benefits.

The investigators said the ideal situation for patients with COPD is to have “uninterrupted” patient care regardless of the setting. Patients should be given clear information about their medications and home care, they should receive home visits, and be monitored for deterioration, the authors wrote. Doing those things in a well-coordinated manner, they believed, could lower the risk of readmission.

“We hypothesized education of timely identification of exacerbation symptoms and the delivery of short acting medications can decrease the risk of hospital readmissions,” they wrote. “Patient health coaching can improve treatment compliance as a key component of self-management approaches, which can be conducted during the home care visits.”

The authors constructed a study looking at outcomes in patients who were enrolled in a respiratory therapist-led COPD Disease Management Program. To study its effectiveness, they compared outcomes of 658 patients who were discharged from 5 hospitals in the Atlantic Health System, prior to the implementation of the program, with outcomes of 435 patients who were discharged and then enrolled in the management program.

Those in the intervention group received a follow-up phone call from a respiratory therapist within 2 days of discharge. The therapist then visited the patient’s home 3 times over a 4-week period. Some patients were visited twice more, based on their progress or lack thereof.

During the home visits, therapists conducted patient education, reviewed the patient’s COPD action plan, and performed COPD assessment tests, among other services. The therapists also consulted with patients’ pulmonologists to ensure that referrals to other providers were carried out.

The intervention appeared to lead to significant improvement. At 30 days, 22.3% of patients who were hospitalized before the launch of the program (pre-intervention group) had been readmitted to the hospital, compared with 12.2% of patients who underwent the post-hospital intervention program. At 60 days, readmission rates were 33.9% and 12%, respectively. By 90 days, all-cause readmissions were 43.5% in the pre-intervention group and 13.1% in the group that received the home visits.

Mansukhani and colleagues said the data showed the program made a meaningful impact on patient outcomes.

“This quality improvement project demonstrated [respiratory therapist] home visits could help reduce readmission rates and prevent penalties,” the authors wrote.

The investigators added that the program appears to be cost effective while also not being cost-prohibitive for their health care system.

“Intervention at home can be easily incorporated into hospital discharge plans while simultaneously not being overbearing for patients, families, or providers,” they concluded.

Reference:

Truumees M, Kendra M, Tonzola D, et al. The impact of a home respiratory therapist to reduce 30 day readmission rates for exacerbation of chronic obstructive pulmonary disease. Respir Care. Published online January 5, 2022. doi:10.4187/respcare.08125