Reduction in Hospital Admissions in an Accountable Care Organziation-Based COPD Program With RT Leadership

Abstract

Background: COPD is the third leading cause of death in the US and is associated with an increase in hospital readmissions. In 2019 there were about 536,000 hospitalizations for patients with COPD.(1,2) A novel program was created to reduce the cost of COPD management by an accountable care organization 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. The participants ranged in age from 53 to 90 years (mean 70.25 years). On average the program is completed over 7 weeks after referral. One of the program goals was to reduce hospital admissions in program participants.

Methods: The study sought to determine if program completion decreased hospital admissions in the following months. This study retrospectively examined the records of 27 patients that completed the program between mid 2022 and early 2023. Only 17 patients had recorded data at both first visit and completion. Each was followed for the number of admissions after program completion.

Results: A paired-sample t-test was conducted to evaluate the impact of the program and the change in the number of inpatient admissions pre and post program. There was a significant decrease in inpatient admission between the prior 12 months (mean 1.8235 [SD .44750]) and post program (mean 0.1176 [SD 0.33211]) , t(4,264), P < .001) (two tailed).

Conclusions: Providing assessment of the patient’s educational and functional skills and then developing a customized care plan for meeting those needs resulted is a reduction in hospital admissions. It is possible that this reduction in hospital admissions will reduce overall cost of care, improve patient satisfaction and health outcomes. The RT role is pivotal in developing and providing educational materials and education to the CaraMedics and patients. Operating in an accountable care oganization environment allows RTs to work to improve outcomes without the restraints normally encountered in a traditional care setting. The study presents research opportunities and demonstrate the effectiveness of programs focused on obtaining positive patient outcomes. 1. American Lung Association. https://www.lung.org/research/trends-in-lung-disease/copd-trends-brief/copd-burden. 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.