SESSION TITLE: Diagnosis of Sleep Apnea
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Monday, October 27, 2014 at 07:30 AM - 08:30 AM
PURPOSE: To screen for OSA overlap 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.
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. Patients were then referred to their physician for further evaluation for diagnostic testing.
CONCLUSIONS: A significant (38%) portion of post exacerbation oxygen dependant COPD patients screened positive (3/8 questions) for OSA, indicating that COPD/OSA overlap is potentially higher than generally understood1. Additionally, a small percentage (5%) of COPD exacerbators were currently on PAP therapy.
CLINICAL IMPLICATIONS: Implementing an OSA screening questionnaire for post discharge COPD patients can identify a significant co morbidity and potentially improve COPD 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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