Home-Based COPD Program Reduces Admissions by More Than 55%

December 17, 2021


TOPIC: Respiratory Care


TYPE: Original Investigations


PURPOSE: To evaluate the impact of multifaceted, ongoing home based COPD management program on hospital admissions.


METHODS: General: 9,091 home based COPD patients were managed over the course of their disease from June 2019 to May 2021 using a goal based, assessment driven COPD Software [Nexus, Encore Healthcare, Livingston TN], administered by a respiratory therapist via in home or telemed visits. The patients accessed the program as part of a prescription for Non Invasive Ventilation from their HME provider. The program deploys objective & subjective assessments to populate an individualized plan of care with a risk/acuity based schedule of visits and goals. The 9,091 patients have received over 278,000 assessments and analytics from the database have processed over 10 million data points. Detailed: Patients with a history of hospitalizations for respiratory failure, diagnosed with COPD and on Non-Invasive ventilatory therapy were enrolled in a home based management program staffed by HME RTs (Nexus, Encore Healthcare). Patients received monthly visits and follow up calls depending on initial risk profile and plan of care improvement. The COVID-19 pandemic most likely disrupted hospitalization and physician office visit patterns, so data from 2018-2019 was used resulting in n=1,487 with length of enrollment of 20 months. 12 month admission history was self reported without claims confirmation and post onboarding admission was confirmed by RT via patient interviews. Two methods were used to understand reductions; first those at least 1 admission without totaling all events; second, total admissions calculated as a rate per patient per month.


RESULTS: Patient self reported hospital admissions post onboarding were measured at 12 months and compared to admission history for the prior 12 months. Patients in the program experienced 60% fewer admissions over prior history.


CONCLUSIONS: Home based COPD management programs led by respiratory therapists using a protocol based software with plan of care goals, can have a significant impacted on COPD admissions and quality of care metrics.


CLINICAL IMPLICATIONS: Understanding prior hospitalizations, current risk factors, and selecting HME providers with post discharge and home based care management programs can support physician and patient outcomes. This demonstrates the opportunity for greater collaboration between physicians, discharge programs and Home Medical Equipment providers to significantly improve COPD management.


DISCLOSURES: Owner/Founder relationship with Encore Healthcare, LLC Please note: 1/1/2016 - 4/30/2021 Added 04/29/2021 by Zach Gantt, source=Web Response, value=Salary


No relevant relationships by Frederic Seifer, source=Web Response



Article Info


Identification

DOI: https://doi.org/10.1016/j.chest.2021.07.2045


Copyright

© 2021 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.