SESSION TITLE: COPD 30-Day Readmission
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Tuesday, October 28, 2014 at 11:00 AM - 12:15 PM
PURPOSE: To compare COPD Assessment Test (CAT) scores & OSA STOPBANG scores with severe, oxygen dependant COPD patients while enrolled in a home respiratory program focused on readmission reduction.
METHODS: The Discharge, Assessment, and Summary @ Home (D.A.S.H., Klingensmith HealthCare, Ford City, PA) program was implemented for home oxygen dependent patients throughout Western Pennsylvania. The program uses face-to-face visits with a respiratory therapist at days 2, and 30 following hospital discharge. Additionally an enhanced DASH is available for patients who qualify for home health services which incorporates Nursing and OT/PT/RT services over 60 days. Weekly care coordinator phone interviews supplement the respiratory therapy visits during that same time period. The program uses educational, behavioral modification, skills training, oxygen titration during activities of daily living, clinical & medication assessment, and adherence data collection. The program has had over 1200 patients enrolled over the last four years and has reduced 30 COPD readmission rate from the mid twenties to below 12%. Patients entering the program were screened for OSA by the respiratory therapist or home care nurse using the STOPBANG questionnaire & additionally the patient completed a COPD dyspnea survey (CAT).
RESULTS: 396 consecutive patients with COPD were enrolled into the DASH program. The thirty day readmission rate (all cause) for this group was 48 (12.1%). 94 of the 396 patients had no STOPBANG score on their initial home visit, of the remaining 302 patients, 15 (5%) were currently on PAP therapy. 287 patients were screened for OSA resulting in 109 (38%) scoring a 3 or higher on the 8 questions. Additionally the 109 patient’s CAT scores were surveyed and 65 (60%) scored a 10 or higher (20/65 were greater than 20), indicating a higher risk of exacerbations according to evaluations of the GOLD 2011 guidelines1.
CONCLUSIONS: A significant (65%) portion of post exacerbation oxygen dependant COPD patients who screened positive (3/8 questions) for OSA, had CAT scores above 10, indicating unresolved dyspnea symptoms and potentially a higher risk of exacerbations according to the COPD 2011 guidelines.
CLINICAL IMPLICATIONS: OSA overlap with COPD is a significant portion of the severe oxygen dependant COPD population. Screening for OSA and identifying unresolved dyspnea can potentially lead to reduced exacerbations, readmissions and mortality.
DISCLOSURE: Dan Easley: Employee: Employee of Klingensmith HealthCare Kimberly Wiles: Employee: Employee of Klingensmith HealthCare The following authors have nothing to disclose: Lyndave Francis, Tariq Cheema, Daniel Shade, Anil Singh
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