The Science Journal of the American Association for Respiratory Care

2010 OPEN FORUM Abstracts

COPD: TRANSITION OF CARE AND REHOSPITALIZATION RATES

Brian W. Carlin1, Kim Wiles2, Dan Easley2; 1Allegheny General Hospital, Pittsburgh, PA; 2Klingensmith Healthcare, Ford City, PA

Background: COPD rehospitalizations within thirty days post discharge in Western Pennsylvania account for up to thirty percent of hospital admissions with cost ranging up to fifty million dollars annually. The overall 30 day readmission rate in this area for these patients approaches 25%. Third party payers are beginning to deny payments for those patients who are rehospitalized within thirty days of discharge. In addition, healthcare reform initiatives are placing an increased emphasis on improving quality, developing and reporting key metrics, and bundling all payments into a single episode of care cost. Achieving a reduction in the readmission rates requires new and innovative relationships between acute care and home care providers. Objective: To develop a home care based, respiratory therapist centered COPD transition of care program to reduce the thirty day rehospitalization rate for patients with COPD exacerbations who use supplemental oxygen therapy. Method: The Discharge, Assessment and Summary @ Home (D.A.S.H., Klingensmith HealthCare, Ford City, PA) program was implemented for home oxygen dependent patients. The program consists of incorporating predischarge patient data with a home care program using face to face respiratory therapist visits at 2, 7, and 30 days following discharge supplemented by 12 care coordinator phone interviews during that same period. The program uses educational, behavior modification, skills training, oxygen titration during ADL activities, clinical assessment, and adherence data collection. Program results were converted into performance metrics for review. Results: 72 patients with COPD were enrolled in the program over a 17 week period. During that time, four rehospitalizations (5.5%) occurred. This represents a 75% reduction in the predicted/historical readmission rate of 22.8% for these patients in this area. Program metrics for goal attainment were established and documented. Conclusions: The use of a respiratory therapist based patient management focused DASH program resulted in a successful decrease in the readmission rate for patients with COPD exacerbations who are using oxygen therapy. Collection of performance data provides valuable insight into patient risk factors for future resource utilization. Sponsored Research - None