The Science Journal of the American Association for Respiratory Care

1998 OPEN FORUM Abstracts


Joe Dwan, RRT, Sheila Jiroch, RRT. Kaiser Permanente. Clackamas, Oregon.

BACKGROUND: In 1996, our HMO had 848 patients receiving home O2 through a contract vendor. Our re-evaluation system was thru the primary care physicians ordering/monitoring their patients O2 needs. Home O2 orders are received from multiple hospitals, physician offices, home health referrals, and clinics. We perceived an overutilization of oxygen. We believed we could achieve improved quality of care by appropriate use of home O2, improved pt satisfaction thru education & monitoring, and cost savings by designating an RCP to monitor usage, qualify new O2 pts and re-evaluate current pts in a timely manner.

METHOD: We created, in essence, a centralized RCP Care Manager for home O2 pts. Created a 20 hr/wk RCP position to develop the program. Utilized in-patient home O2 protocol. Developed a communication system between the home oxygen vendor, insurance coordinators, physicians and the RCP. Initiated electronic charting & ordering system. Provided pt education. Created a link between RCP evaluation system in the hospital to the RCP evaluation of outpts. Collected data on # of pts receiving new O2 evaluation & re-evaluation, status post evaluation; # discontinued per Medicare criteria, # of pts whose O2 needs changed, # of new pts evaluated, an # of pts on home oxygen. Results: In the first year of this project, 441 pts were seen from December-October, including 108 as new evaluations and 333 as re-evaluations for home oxygen. Utilizing the Medicare criteria (PaO2 < =55 torr or SaO2 < =88%), 31 new pts began home O2 (29%) and 12O(36%) re-evaluated pts were discontinued on home O2. The time between discharge from hospital and re-evaluation also improved. Communication amongst those involved significantly improved. Annualized cost savings for the 36% of reevaluated pts was $288,000. Annualized cost savings for new pts was $184,000. Total annualized savings for the project was $472,000.

CONCLUSION: An RCP as a care manager for home O2 pts has improved quality of our care by providing home O2 when pts need it and removing it when it is no longer needed. Patient education was essential in improving the care. Our experience shows that pts lack an understanding of oxygen, of SOB & its relation to hypoxia & activity. A large cost savings realized by the .5FTE RCP.

The 44th International Respiratory Congress Abstracts-On-DiskĀ®, November 7 - 10, 1998, Atlanta, Georgia.

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