March 23, 2023 | Case Study by: Ray Gregg - CRT, RPSGT; Missy Hill - RRT; Jason Hale – RRT
Chronic Respiratory Failure: The Vicious Cycle
Patients with severe chronic respiratory disorders such as COPD, pulmonary fibrosis, and the like are often challenged by the progressive nature of their condition. It is not uncommon for these patients to struggle with an increasing burden of disease, including steadily worsening symptoms, declines in both activities of daily living and overall quality of life, and increasing bouts of anxiety and depression. In addition, exacerbation flare-ups and hospitalizations are part of a complex, vicious cycle that chronic respiratory patients often find themselves trapped in.
A Patient-Centric HME
In an effort to help their patients avoid being caught up in this downward spiral, the members of the HME care team at Med-South, Inc. have long been proponents of proactive patient engagement and early therapeutic intervention, including the use of advanced therapies such as non-invasive ventilation (NIV) and high-frequency chest wall oscillation (HFCWO). To help facilitate the management of these patients, Med-South was an early adopter of Encore Healthcare’s Nexus software platform.
A Systematic Approach to Clinical Management
Nexus is a respiratory outcomes-focused software platform and clinical management
program. Nexus was designed to serve as the day-to-day clinical management hub for HMEs and allows for a systematic approach to managing COPD and chronic respiratory patients based on GOLD guidelines and evidence-based best practices. The Nexus software program has been utilized by Med-South and other providers across the US in approximately 70,000 patients to drive measurable outcome improvements such as reductions in hospitalizations and ER visits, decreases in disease-related symptom burden, and improvements in respiratory medication management, patients’ ability to self-manage, and overall quality of life. Since its implementation, Med-South has used Nexus to manage over 2,200 advanced therapy patients and decrease hospital readmissions by 66% on average.
Med-South Nexus Results
Peggy is one such patient that has experienced positive results due to Med-South’s patient-centric approach and Nexus’ focus on outcomes. Peggy, age 67, was hospitalized with a severe and lengthy Covid infection in late 2020, and consequent to the infection, was diagnosed with pulmonary fibrosis (PF). Peggy was discharged home in early 2021 and was placed on continuous oxygen therapy. Peggy spent much of 2021 essentially homebound, with the exception of physician appointments, as she struggled with gradually increasing symptoms such as shortness of breath and limited ability to perform activities of daily living. Peggy eventually experienced a repeat hospitalization in late 2021. Upon discharge, she required an increase in her oxygen liter flow of up to 4 LPM, resulting in her husband needing to come to the Med-South branch every few days to pick up oxygen tank refills.
During one such trip to the branch, a conversation with one of the branch respiratory therapists (RT) resulted in the therapist becoming concerned upon hearing about Peggy’s struggles. The RT scheduled a home visit and performed a comprehensive respiratory assessment on Peggy and documented that Peggy’s worsening condition was primarily ventilatory in nature. An account executive then provided the assessment to Peggy’s physician for review and discussion. Med-South’s account executive team serves as physician liaisons and works collaboratively with their assigned branch’s clinical and operational teams to keep physicians and referral sources informed regarding their patients’ status in the home. Based upon a review of the home assessment, Peggy’s physician scheduled her for an in-office visit to verify the results and diagnosed Peggy with chronic respiratory failure. Med-South worked with the physician and Peggy’s insurance to obtain the necessary testing and approval, and Peggy was started on home NIV therapy in November of 2021.
During Peggy’s initial onboarding period, Med-South’s RT worked with Peggy to adjust some of the NIV device’s comfort features, along with her mask, to help Peggy better acclimate to her new therapy. In addition to providing Peggy with education on her NIV device, Med-South also utilized the Nexus software to help build an individualized plan of care for Peggy with personalized motivational goals to help drive patient engagement. The Nexus platform also assigned a series of clinical assessments to administer to Peggy based on Med-South’s cadence of live follow-up visits. These assessments helped measure and track Peggy’s overall improvement and also provided the RT with patient instruction and intervention suggestions when needed. Nexus also tracks individual patient outcomes, as well as whole populations, in its database and provides Med-South’s account executive team with detailed summary reports regarding both overall patient status and specific plan of care progress that can be provided back to the patient’s physician and care team.
Peggy has now been on NIV therapy and managed in the Nexus platform for nearly fifteen months and has demonstrated a remarkable improvement in her disease trajectory. Peggy states that her NIV device is “the most wonderful thing that has come my way.” Peggy reports feeling refreshed when she wakes up after a night of NIV support and is not out of breath during the day like she was prior to starting therapy. This decrease in her daily symptom burden has now allowed Peggy the ability to go to the grocery store on her own and to perform household chores, both of which were components of her Nexus motivational goals. Peggy also has reported a decrease in the brain fog and mental fatigue that she would often experience prior to being prescribed NIV therapy. In the fifteen months since starting on NIV and having her outcomes tracked in the Nexus platform, Peggy has not experienced any rehospitalizations or ER visits, and her underlying ventilatory status has improved to the point where her physician has recently been able to wean her off of her previous supplemental oxygen therapy.
Peggy’s story is one that demonstrates how getting the right patient on the right therapy at the right time can have an enormous positive impact on their overall outcomes and quality of life. By equipping their knowledgeable and patient-centric clinicians with the latest therapeutic devices and a software-based, whole patient-focused, management platform, Med-South continues to achieve its foundational goal of “Helping People Live Better.”
About the Authors
Ray Gregg is the Vice President of Sales & Business Development for Encore Healthcare. Missy Hill is Clinical Administrator and Jason Hale is the Director of Clinical Services for Med-South, Inc. & Affiliates.
Nexus is an outcome-focused respiratory management program that’s elevating respiratory care in the Home Medical Equipment industry. Better patient data, smarter reporting, more referrals–Nexus represents a fundamental shift in home respiratory care. Where traditional HME methodology has focused on monitoring the relationship between equipment and patient, Nexus introduces proven clinical protocols that dramatically improve both engagement and outcomes — all in a complete, scalable platform that grows with your needs. We’ve taken our direct experience in the HME segment, combined it with proven, outcome-based protocols, and applied gold-standard clinical guidelines. All to create a disease management platform that:
Creates long-term engagement between patients, programs, and providers.
Improves patient care and progress.
The result for you? Actionable data, goal-based outcomes, and more physician referrals