The Science Journal of the American Association for Respiratory Care

2011 OPEN FORUM Abstracts


Kimberly S. Wiles, Dan Easley; Klingensmith HealthCare, Ford City, PA

COPD patients are often discharged from the hospital with minimal information and very little follow up. The 30 day readmission rate in western Pennsylvania is 25%. With rehospitalization penalties imminent, it is important to implement programs targeting chronic disease management. The imperative with a transition program is that the patient and caregivers are given the knowledge to achieve an independent lifestyle. Objective: To evaluate 30 day patient satisfaction following a respiratory therapist driven COPD management program. Method: COPD patients requiring supplemental oxygen were admitted into a chronic disease management program, DASH (Discharge + Assessment & Summary at Home). The program consisted of 3 home visits by a respiratory therapist within 30 days to educate, titrate oxygen during activities of daily, monitor oxygen compliance and adherence, etc. The patient established a motivational goal and a plan of care was developed around the achievement of that goal. The RT visits were supplemented with several phone calls by an in-house clinical care coordinator. A survey was completed by the patient after 30 days. Results: 20/31 patients completed the 30 day DASH program and returned a 30 day satisfaction survey. * 100% reported a better understanding of the disease * 55% achieved their motivational goal that was established on the initial home visit * Zero patients reported a hospital admission due to COPD * 85% knew what to do in a "flare up" * 2 patients called their physician regarding a "flare up", but avoided a hospital admission * 95% knew how and when to take their medications * 80% understood how the various breathing techniques to help control shortness of breath * 90% were able to complete home activities on their own at the end of the 30 day program * 3 of the 20 patients were involved in a pulmonary rehab program Conclusion: A respiratory therapist driven COPD transition of care program significantly increases patient confidence and perception of independence, while decreasing hospital 30 day readmissions.
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