Obstructive Lung Diseases |

Performance of Activities of Daily Living (ADLs) as a Marker for the 30 Day Rehospitalization Rates for Patients With COPD Exacerbations FREE TO VIEW

Brian Carlin*, MD; Dan Easley, BS; Kim Wiles, RRT
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Drexel University School of Medicine, Pittsburgh, PA

Chest. 2012;142(4_MeetingAbstracts):734A. doi:10.1378/chest.1390745
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SESSION TYPE: COPD: Diagnosis and Evaluation

PRESENTED ON: Sunday, October 21, 2012 at 01:15 PM - 02:45 PM

PURPOSE: To evaluate how a patient's ability to perform ADLs in the home setting relate to the rehospitalization rates following hospitalization for a COPD exacerbation.

METHODS: Patients with a COPD exacerbation who required supplemental oxygen therapy on hospital discharge were entered into a post hospitalization transition of care program {Discharge, Assessment and Summary @ Home (D.A.S.H., Klingensmith HealthCare, Ford City , PA)]. All patients required supplemental oxygen therapy on discharge. The program consists of face to face visits by a respiratory therapist with the patient on days 2, 7, and 30 following hospital discharge. 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. The 30 day readmission rates following discharge for all patients entered into the program over a two year period (March 2010 through March 2012) were evaluated and compared to the ability to perform a series of ADLs in the home environment.

RESULTS: 192 consecutive patients with COPD were enrolled into the 30 day program. The thirty day readmission rate (all cause) for this group was 17 (8.9%). Five (2.6%) were readmitted with a diagnosis of COPD exacerbation. 102/192 (53%) were able to perform 4 of 4 ADLs measures to completion on visit 1. 16/192 (8.3%)could only perform 0 or 1 ADL to completion on visit 1. For those patients who were only able to perform 0 or 1 ADL at the initial visit, the 30 day rehospitalization rate was 18% (3/16). 70% of patients were able to perform at least the same number of ADLs or more at the end of the 30 day period. For the other 30% who had a decrease in the ability to perform the same number ADLs, the 30 day rehospitalization rate was 5/17 (29%).

CONCLUSIONS: This transition of care program has resulted in a decrease in the 30 day rehospitalization rates for patients with COPD exacerbation. Predictors of rehospitalization include the performance of less than 2 of 4 ADLs in the home environment immediately following discharge or a decrease in the ability to maintain or perform ADLS during the following four week period.

CLINICAL IMPLICATIONS: The assessment of performance of ADLs in the home setting may help to provide a marker for those patients who are likely to require rehospitalization.

DISCLOSURE: Dan Easley: Employee: Klingensmith HealthCare

Kim Wiles: Employee: Klingensmith HealthCare

The following authors have nothing to disclose: Brian Carlin

No Product/Research Disclosure Information

Drexel University School of Medicine, Pittsburgh, PA




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