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Critical Care |

Hospital Utilization for COPD Patients Requiring Noninvasive Positive Pressure Ventilation Enrolled in Home-Based Pulmonary Rehabilitation

Zachary Gantt, RRT; Dov Hirsch, MA
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Alana HealthCare, Nashville, TN


Chest. 2014;146(4_MeetingAbstracts):337A. doi:10.1378/chest.2050330
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Abstract

SESSION TITLE: Late-Breaking Abstracts

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Tuesday, October 28, 2014 at 08:45 AM - 10:00 AM

PURPOSE: To measure the impact of a home-based, respiratory therapist-led health management program on hospital utilization among patients living with chronic respiratory failure who require non-invasive positive pressure ventilation (NIPPV).

METHODS: The Comprehensive Respiratory Outcome Management (CROM, Alana HealthCare) program was implemented for patients living with chronic respiratory failure and require the use of non-invasive positive pressure ventilation. The program consists of face-to-face home visits by a respiratory therapist who performs clinical assessments, intensive education, behavior modification, skill training, smoking cessation and exacerbation mitigation/management training. Home visits are supplemented with scheduled and unscheduled respiratory therapist phone interviews. Patients with a diagnosis of chronic respiratory failure, either ≥ 1 hospital admission or ≥1 emergency room visit in the past 12 months and/or for whom a BIPAP has proven to be ineffective were enrolled into the program.

RESULTS: 459 patients were enrolled into the program over an 18-month period (January 2012 through June 2013) with a diagnosis of chronic respiratory failure. 211(46%) of those enrolled had a diagnosis of chronic respiratory failure and experienced a minimum of 1 hospital admission in the 12-month period prior to enrollment into the program, and 61 (13%) of those enrolled had a minimum of 1 hospital readmission (30-day) in the 12-month period prior to enrollment into the program. Following enrollment and participation in the program, patients experienced a 51% reduction in hospital admissions, a 56% reduction in days spent in the hospital and a 48% reduction in 30-day hospital readmissions. Analysis was done using equivalent time periods, pre and post start of care.

CONCLUSIONS: The use of a respiratory-therapist led health management program resulted in a decrease in hospital utilization amongst patients living with chronic respiratory failure, as defined by admissions, days spent in the hospital and 30-day readmissions.

CLINICAL IMPLICATIONS: Nationally, hospital utilization for patients living with chronic respiratory failure is among the highest in the nation. This respiratory health management program helps to significantly reduce admissions (51%), days spent in the hospital (56%) and hospital readmissions (48%). Significant reductions in health care related expenditures can thus be expected.

DISCLOSURE: Zachary Gantt: Employee: Employed by Alana Healthcare Dov Hirsch: Employee: I am a full-time employee of Alana HealthCare, the organization that conducted this analysis and provides care for the patients studied.

No Product/Research Disclosure Information


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