The Impact of a Home Respiratory Care Practitioner to Reduce 30-day Readmission Rates for COPD Exacerbation

Abstract

Background: In 2015, the Centers for Medicare and Medicaid Services (CMS) limit payments to hospitals with high readmission rates for patients admitted with acute exacerbation of COPD (AECOPD). Decreasing readmissions in this patient population improves patient health and decreases healthcare utilization of resources. We hypothesized a COPD Management Program (COPD-MP), delivered by a respiratory care practitioner (RCP) in the patient’s home would reduce readmission rates for AECOPD.

Methods: We performed a pre/post-intervention design study, comparing hospital readmissions for AECOPD patients who received standard of care in the home versus a RCP-led COPD-MP. From January 2016 to March 2017, patients discharged home from Atlantic Health System (AHS) with AECOPD were enrolled in the pre-intervention group. Subsequently, an evidence-based COPD-MP was implemented by an RCP from At Home Medical (AHM) in the home. The COPD-MP was implemented in the patient’s home from April 2017 until September 2019 and this served as the post-intervention group.

Results: A total of 835 patients were included in the pre-intervention cohort and 576 patients in the COPD-MP. There was a reduction in 30-day all cause readmission between the pre-intervention cohort and the COPD-MP cohort (17.6% vs. 11.3%, P=0.001). There was also a reduction in 60-day all cause readmissions (26% vs. 12.5%, P<0.001) and 90-day all cause readmissions (33% vs. 12.5%, P<0.001).

Conclusions: Utilizing an evidence-based RCP-led COPD-MP approach, in the post discharge period is crucial in preventing recurrent hospitalizations. This quality improvement project in COPD-MP established an innovative strategy implemented by an RCP in the discharge period to reduce readmission rates. A review of the data demonstrated a 35% reduction in 30-day readmissions when a COPD-MP was implemented in the patient’s home. There was also a reduction in 60-day and 90-day readmission by 52% and 62% respectively.