Abstract
Background:
COPD is the third leading cause of death in the US and is associated with an increase in ED utilization. In 2019 there were about 1,320,000 ED visits for patients with COPD.(1,2) A novel program was created to reduce the cost of COPD Management (including ED utilization) by an accountable care oganization in western North Carolina. The program consists of education and assessment by a team of CaraMedics (Licensed Paramedics with special program training), an RN and an RT. Participants ranged in age from 53 to 90 years (mean 70.25 years). On average the program is completed over 7 weeks after referral.
Methods:
The study sought to determine if program completion decreased ED visits in the following months. The study retrospectively examined the records of 27 patients that completed the program between mid 2022 and early 2023. 17 patients had recorded data at both first visit and completion. Each patient was followed for the number of days between program completion and ED admission. IRB approval was waived due to NIH Exemption 4.
Results:
A paired-sample t-test was conducted to evaluate the impact of program and the change in ED visits for the prior 12 months and after program completion. There was a statistically significant decrease in the number of ED admissions from the prior 12 months (mean 1.8235 [SD 1.84510]) and post program completion (mean 0.1176 [SD 0.08055]), t(4.264, P < .001 (two tailed)).
Conclusions:
Assessing a patient’s educational and functional capacity and then developing a customized care plan for meeting those needs resulted in a reduction in ED utilization. This reduction in ED utilization may reduce overall cost of care and improve both patient satisfaction and health outcomes. The RT is pivotal in developing and providing educational materials and education to the CaraMedics and patients. The accountable care oganization environment allows RTs to work to improve outcomes without cost restraints encountered in a traditional care setting. This study provides the basis for further research opportunities and demonstrates the effectiveness of RT-driven programs designed to create positive patient-focused outcomes.1. American Lung Association. COPD trends brief: burden. http://www.lung.org/research/trends-in-lung-disease/copd-trendsbrief. 2. Kumbhare SD. Characteristics of COPD patients using United States emergency care or hospitalization. COPD 2016; 3(2):539-548. doi: http://dx.doi.org/10.15326/jcopdf.3.2.20150155
ED Visits 12 months Prior and Post Program
Patient
12 Month Prior ED Visit
Post Program ED Visit
Pt 1
2
0
Pt 2
0
0
Pt 3
2
0
Pt 5
0
0
Pt 7
0
0
Pt 8
2
0
Pt 9
2
0
Pt 10
0
0
Pt 11
2
0
Pt 12
3
1
Pt 14
7
1
Pt 15
1
0
Pt 16
2
0
Pt 17
3
0
Pt 18
0
0
Pt 19
0
0
Pt 20
4
0
Mean
1.76
.1176
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