Comparison of Therapist-Directed and Physician-Directed Respiratory Care in COPD Subjects With Acute Pneumonia

BACKGROUND: The purpose of this retrospective medical record review was to compare the effects of therapist-directed (protocol RT) and physician-directed (non-protocol RT) respiratory therapy on hospital stay and 30-d post-discharge readmission in COPD subjects with acute bacterial pneumonia.

METHODS: We reviewed 320 medical records; 244 records were usable. Information gathered included gender, age, RT protocol type (protocol RT or non-protocol RT), hospital stay, 30-d post-discharge readmission, and disease severity score. A 3-way analysis of variance and post hoc analysis were performed to determine the possible effects of disease severity, age, and RT protocol type on hospital stay and the possible interaction effects among these independent variables. A chi-square test for independence was computed to determine whether there was an association between RT protocol type and 30-d readmission.

RESULTS: There were no significant interaction effects among RT protocol type, age, and disease severity on hospital stay. In addition, there were no significant effects of either RT protocol type (P = .41) or age (P = .85) on hospital stay in our subject sample. However, as expected, disease severity had a significant effect on hospital stay, increasing it by a mean of 2.6 d (95% CI 0.77–4.4, P = .005). The chi-square test for independence revealed that the frequency of 30-d readmission was significantly associated with RT protocol type (P = .02); fewer 30-d readmissions were associated with protocol RT.

CONCLUSIONS: We interpreted the finding of no difference in mean hospital stay between protocol and non-protocol RT to indicate that protocol RT did not confer a disadvantage to subjects in terms of hospital stay. Additionally, the results suggest that treatment efficacy is not sacrificed when RT is directed by respiratory therapists rather than by physicians regardless of disease severity and that therapist-directed protocols may have been of some benefit in reducing 30-d post-discharge readmission.