Cystic Fibrosis Post-Discharge Telehealth for Pulmonary Exacerbations

Abstract

Background: Cystic fibrosis (CF) is a genetic disease resulting in significant respiratory morbidity and mortality. Pulmonary exacerbations are detrimental to this populations’ lung function and quality of life. The rate of readmissions with respiratory therapist (RT) intervention via telehealth following hospitalization for pulmonary exacerbation is unknown. Telehealth can be a valuable tool to coordinate early intervention and education when needed. This study investigated the impact of telehealth intervention with CF specific education provided by the RT pulmonary navigator.

Methods: Patients admitted for CF pulmonary exacerbations were voluntarily enrolled in our UBreathe Readmissions program. Prior to discharge, patients received a specific CF action plan to assess symptom severity daily and an educational session of airway clearance therapy (ACT) focused on autogenic drainage and huff coughing. Participants were asked 16 questions from the respiratory section of the CF RISE questionnaire to assess baseline understanding of their disease. During post-discharge telehealth visits, RTs reviewed topics from the questionnaire and ACT training including intensive autogenic drainage and huff coughing. Patients completed surveys 30 d after discharge assessing symptoms and repeat CF RISE questions.

Results: Six subjects (3 females, 3 males) admitted for pulmonary exacerbations were enrolled in the study. There were no readmissions for pulmonary exacerbation at 30 d for this cohort. Of the 6 participants, 3 responded at 30-d follow-up indicating no interval illness requiring urgent care or emergency department visits. Three participants did not respond to follow-up surveys but were seen in routine clinic follow-up at various times. Mean baseline score on CF RISE questionnaire from all participants was 80%. Re-assessment using CF RISE at 30 d yielded a mean score of 95.8% of respondents.

Conclusions: In this QI study cohort, findings suggest use of telehealth follow-up led to improvement in patient education relating to CF physiology and treatment while enhancing their performance using AD and huff coughing as part of their airway clearance routine. Further study utilizing short term telehealth visits following discharge assessing technique deficits while also providing education to prevent readmissions for CF pulmonary exacerbations is recommended and appears feasible from our initial study.