Using NEXUS to Uncover Gaps in Care

January 11, 2022


TOPIC: Respiratory Care


TYPE: Original Investigations


PURPOSE: By analyzing gross score and individual question scores within CAT, as well as changes in scores, better targeted COPD interventions an be identified.

METHODS: General: 9,091 home based COPD patients were managed over the course of their disease from January 2018 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 datapoints. Detailed: Patient symptoms were measured using the COPD Assessemnt Test (CAT) at initial visit and regular intervals. The test entails 8 questions with answers scaled from 0-5, (5 = most severe impact). The questions were grouped into 3 domains: airway clearance symptoms (Cough, Phlegm, Chest tightness), activity (Walking, Activities, Going out), and pre-hypercapnia (sleep, energy). The Software sorted total scores over 20, or specific symptom answers >=4, and the patients received focused discussion & education from the RT on each visit. The patient scores were also indexed to history of Respiratory Infections, Hospitalizations for COPD, GOLD Staging and Grouping.


RESULTS: Of the 1905 (42%) patients with a reported history of respiratory infections and multiple CAT assessments, 16% scored a 4 or 5 symptom impairment on any of the 3 airway clearance questions. Screening COPD patients for both history of respiratory infection and CAT airway clearance issues revealed that 16% of the patients with a history of infections also had significant airway clearances issues as evidenced by the CAT assessment.


CONCLUSIONS: Home based COPD management programs led by respiratory therapists using a protocol based software with plan of care goals, can alert physicians and assist patients in targeting specific therapies to improve symptom management. By combining respiratory infection history with specific CAT questions relating to airway clearance, patients can be identified for more targeted therapies.


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


No relevant relationships by Frederic Seifer


Article Info

Identification

DOI: https://doi.org/10.1016/j.chest.2021.07.2047


Copyright

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