PURPOSE: To evaluate the effects of a home-care based, respiratory therapist centered transition of care program for patients who require home oxygen therapy following hospital admission for either an exacerbation of chronic obstructie pulmonary disease (COPD) or congestive heart failure (CHF).
METHODS: The Discharge, Assessment and Summary @ Home (D.A.S.H., Klingensmith HealthCare) program was implemented for patients who require supplemental oxygen use following hospital admission. The program consists of face to face visits by the respiratory therapist with the patient on days 1, 7, and 30 following hospital discharge. The visits are supplemented by 12 care coordinator phone interviews. Education, behavior modification, skills training, oxygen titration during performance of activities of daily living, clinical assessment, and adherence data collection are components of the program. Patients with either a COPD or CHF exacerbation who required supplemental oxygen therapy on discharge from twenty three hospitals were enrolled into the program.
RESULTS: 245 consecutive patients were enrolled in the program over a nine month period (March 2010 through January 2011). 229 (93%) were discharged following an exacerbation of COPD and 16 (7%) following an exacerbation of CHF. Thirteen (5% of total) patients with a COPD exacerbation were readmitted within 30 days and no (0%) patients with a CHF exacerbation were readmitted within 30 days. For those patients with a diagnosis of COPD, 5 (2%) were readmitted with another COPD exacerbation and 8 (3.4%) were readmitted for other reasons (e.g. CHF exacerbation, fall).
CONCLUSIONS: The use of a respiratory therapist based patient centered management program resulted in a decrease in the 30 day readmission rates by 80% for patients who required supplemental oxygen therapy following a hospitalization for an exacerbation of either COPD or CHF.
CLINICAL IMPLICATIONS: The current 30 day readmission rates in Western Pennsylvania following an exacerbation of either COPD or CHF approach 25%. This transition of care program has helped to significantly reduce 30 day hospital readmission rates (to below 5%). Significant reduction in healthcare related expenditures can thus be expected.
DISCLOSURE: Kim Wiles: Employee: Current employee of Klingensmith HealthCare
Dan Easley: Employee: current employee of Klingensmith HealthCare
The following authors have nothing to disclose: Brian Carlin, Nan Rees
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