2012 OPEN FORUM Abstracts
DYSPNEA SCORES AND ACTIVITIES OF DAILY LIVING CAPABILITY AS PREDICTORS OF REHOSPITALIZATION RATES IN A 30 DAY HOME RESPIRATORY CARE PROGRAM.
Brian W. Carlin1, Dan Easley2, Kim Wiles2; 1Sleep Medicine and Lung Health Consultants, Ingomar, PA; 2Klingensmith HealthCare, Ford City, USA Minor Outlying Islands
Abstract Background: The overall 30 day readmission rate for patients who have been hospitalized following hospitalization for a COPD exacerbation approaches twenty five percent in Western Pennsylvania. Predictors for rehospitalization are necessary to help target those patients who are at an increased risk for rehospitalization. Objective: To measures level of dyspnea as related to ADL capability and its impact on rehospitalization rates for COPD exacerbations. Methods: The Discharge, Assessment, and Summary @ Home (D.A.S.H., Klingensmith HealthCare, Ford City, PA) program was implemented for home oxygen dependent patients throughout Western Pennsylvania. The program uses face-to-face visits with a respiratory therapist at days 2, and 30 following hospital discharge. Additionally an enhanced DASH is available for patients who qualify for home health services which incorporates Nursing and OT/PT/RT services over 60 days. Weekly care coordinator phone interviews supplement the respiratory therapy visits during that same time period. The program uses educational, behavioral modification, skills training, oxygen titration during activities of daily life, clinical assessment, and adherence data collection. The 30 day readmission rate for all patients was assessed. Four patient selected activities of daily living were measured at each of the visits. Dyspnea, as measured by Borg scores, was measured post performance of a self selected ADL at the 2 day visit. Assessment of 30 day rehospitalization rate was measured. Results: 192 patients with COPD completed the program over a twenty four month period (January 1, 2010 through December 30, 2011). Overall, 17 (8.8%) patients were readmitted within a 30 day period. 102 of 192 (53%) patients had a Borg score of 3 or greater. Of these 102, 10 (10%) required readmission. The readmission rates for patients who could perform (at the time of the 2 day visit) 4 of 4 ADLs was 6.9%, 3 of 4 ADLs was 12.2%, 2 of 4 ADLs was 4%, 1 of 4 ADLs was 16.7%, and 0 of 4 ADLs was 20%. Combining ADLs and level of dyspnea did not improve prediction of rehospitalization. Conclusions: Performance of only 0 or 1 of 4 ADLs is predictive of a higher risk of rehospitalizaton. Level of dyspnea and ADL performance appear to be independent predictors of risk of rehospitalization Sponsored Research - Study is part of a program conducted by Klingensmith HealthCare.