The Impact of a Home Respiratory Therapist to Reduce 30 day Readmission Rates for Exacerbation of Chronic Obstructive Pulmonary Disease

INTRODUCTION: In 2015, the Centers for Medicare and Medicaid Services (CMS) limited payments to hospitals with high readmission rates for patients admitted with COPD exacerbation. Decreasing readmissions in this patient population improves patient health and decreases healthcare utilization of resources. We hypothesized a COPD Disease Management Program, delivered by a respiratory therapist (RT) in the patient’s home may reduce readmission rates for COPD exacerbation.

METHODS: We performed a pre/post-interventional study comparing hospital readmissions for subjects with COPD exacerbation that received standard of care in the home versus an RT-led home COPD Disease Management Program. Subjects discharged home from Atlantic Health System with COPD exacerbation were enrolled in the pre-intervention group. Subsequently, an evidence-based home COPD Disease Management Program was implemented by an RT from At Home Medical in the home. The home COPD Disease Management Program was implemented from April 2017 until September 2019 and this served as the post-intervention group. The primary endpoint was readmission rates at 30 days. Secondary endpoints included 60 and 90 day readmission rates.

RESULTS: A total of 1,093 participants were included in the study, 658 in the pre-intervention cohort and 435 participants in the post-intervention group. Approximately 22.3% (n=147) of subjects in the pre-intervention group were readmitted within 30 days of discharge compared 12.2% (n=53) in the post-intervention group (p<0.001). A reduction in 60 day (33.9% vs. 12.0%, p<0.001) and 90 day all cause readmissions (43.5% vs. 13.1%, p<0.001) was also seen. Participation in the COPD Management Program was significantly associated with decreased 30, 60, and 90 day readmission rates adjusting for age, gender, race, ethnicity, and smoking status (OR [95% CI]=0.48 [0.33, 0.70], 0.26 [0.18, 0.38], 0.20 [0.14, 0.27]; p<0.001 for all three readmission rates).

CONCLUSIONS: The Disease Management Program is significantly associated with decreased readmission adjusting for demographics and smoking status.