Impact of a Respiratory Therapist Home Visit Program Post Hospitalization to Decrease Readmission and Emergency Room Visits for COPD Patients in a Primary Care Network

Abstract

Background:

COPD is now the 3rd leading cause of death in the U. S. The 30-day readmission rate for acute exacerbation of COPD is approximately 20%. The Signature Partners Network (SPN) wanted to improve the quality of care for their COPD population by reducing emergency department (ED) visits and hospital COPD exacerbation admissions and readmissions. SPN developed a COPD Home Education Initiative to determine ways to track COPD hospitalized case findings and increase appropriate management of the COPD population. This led to a strong collaboration between SPN and the Inova Fairfax Hospital Pulmonary Rehabilitation Department. The Pulmonary Rehabilitation (PR) Respiratory Therapist (RRT) Home Visit Pilot program was developed to follow SPN COPD patients. The RRT Home Visit is free to the patient and the staff time is paid from the SPN budget.

Methods:

Hospitalized SPN COPD patients upon discharge were referred for a RRT home visit by their primary care physician. The patient had to agree to have the home visit and PR RRT would then schedule the patient. The Home visit commenced within 11.8 days of the Referral. The RRT evaluated the patients in their home setting and provided education regarding COPD care management to prevent exacerbations and improve quality of life. The Respiratory therapist provided their recommendations to patients' PCP for co-ordination of care. Below is the one year data: Admissions Before Home Visit Program is 62 and After Home Visit Program is 34 COPD Admission Before Home Visit is 44 and After Home Visit is 13 Non-COPD Admissions Before Home Visit is 18 and After Home Visit is 21 ED Visits Before Home Visit Program is 29 and After Home Visit Program is 16 COPD ED Visits Before Home Visit is 17 and After Home Visit is 3 Non-COPD ED Visits Before Home Visit is 12 and After Home Visit is 13 Chi-Square Test: Admission was P=0.0018 and ED Visits P=0.0100.

Conclusions:

The impact and success of the SPN COPD Home Education Pilot Initiative has shown a significant reduction in both COPD exacerbation hospitalizations and ED visits. The team did a great job in identifying appropriate COPD patients. Challenges were getting referral orders from the primary care providers for the home visits. The SPN leadership plans to continue to determine ways of identifying and referring patient's into the RRT home visit program, even before the patient is discharged from the ED or hospital and increase the use of this program.

Disclosures:

None.