TY - JOUR
T1 - A respiratory therapist disease management program for subjects hospitalized with COPD
AU - Silver, Patty C.
AU - Kollef, Marin H.
AU - Clinkscale, Darnetta
AU - Watts, Peggy
AU - Kidder, Robin
AU - Eads, Brittany
AU - Bennett, Debbie
AU - Lora, Carolyn
AU - Quartaro, Michael
N1 - Publisher Copyright:
© 2017 Daedalus Enterprises.
PY - 2017/1
Y1 - 2017/1
N2 - BACKGROUND: Patients with COPD often require repeated emergency department visits and hospitalizations for COPD exacerbations. Such readmissions increase health-care costs and expose COPD patients to the added risks of nosocomial infections and increased mortality. METHODS: To determine whether a respiratory therapist (RT) disease management program could reduce rehospitalization and emergency department visits, a prospective, single-center, unblinded, randomized trial was performed. RESULTS: We enrolled 428 subjects (214 intervention, 214 control). The primary outcome (combined non-hospitalized emergency department visits and hospital readmissions for a COPD exacerbation during the 6-month follow-up) was similar for the study groups (91 vs 159, P =.08). When the 2 components of the primary end point were analyzed individually, the percentage of subjects with non-hospitalized emergency department visits for COPD exacerbations was similar between groups (15.0% vs 15.9%, P =.79). Readmission for a COPD exacerbation was significantly lower in the intervention group (20.1% vs 28.5%, P =.042). The median (interquartile range) duration of hospitalization for a COPD exacerbation was less for the intervention group (5 [3–11] d vs 8 [4–18.5] d, P =.045). In-patient hospital days (306 d vs 523 d, P =.02) and ICU days (17 d vs 53 d, P =.02) due to COPD exacerbations were significantly less for the intervention group. Mortality was similar for both groups (1.4% vs 0.9%, P >.99). CONCLUSIONS: Our RT disease management program was associated with less readmission, fewer ICU days, and shorter hospital stays due to COPD exacerbations. Further studies are needed to determine the optimal utilization of RT disease management teams for patients with COPD to optimize outcomes and prevent return hospital visits. (ClinicalTrials.gov registration NCT01543217.).
AB - BACKGROUND: Patients with COPD often require repeated emergency department visits and hospitalizations for COPD exacerbations. Such readmissions increase health-care costs and expose COPD patients to the added risks of nosocomial infections and increased mortality. METHODS: To determine whether a respiratory therapist (RT) disease management program could reduce rehospitalization and emergency department visits, a prospective, single-center, unblinded, randomized trial was performed. RESULTS: We enrolled 428 subjects (214 intervention, 214 control). The primary outcome (combined non-hospitalized emergency department visits and hospital readmissions for a COPD exacerbation during the 6-month follow-up) was similar for the study groups (91 vs 159, P =.08). When the 2 components of the primary end point were analyzed individually, the percentage of subjects with non-hospitalized emergency department visits for COPD exacerbations was similar between groups (15.0% vs 15.9%, P =.79). Readmission for a COPD exacerbation was significantly lower in the intervention group (20.1% vs 28.5%, P =.042). The median (interquartile range) duration of hospitalization for a COPD exacerbation was less for the intervention group (5 [3–11] d vs 8 [4–18.5] d, P =.045). In-patient hospital days (306 d vs 523 d, P =.02) and ICU days (17 d vs 53 d, P =.02) due to COPD exacerbations were significantly less for the intervention group. Mortality was similar for both groups (1.4% vs 0.9%, P >.99). CONCLUSIONS: Our RT disease management program was associated with less readmission, fewer ICU days, and shorter hospital stays due to COPD exacerbations. Further studies are needed to determine the optimal utilization of RT disease management teams for patients with COPD to optimize outcomes and prevent return hospital visits. (ClinicalTrials.gov registration NCT01543217.).
KW - Chronic obstructive pulmonary disease
KW - Disease management
KW - Hospital readmission
UR - http://www.scopus.com/inward/record.url?scp=85026820429&partnerID=8YFLogxK
U2 - 10.4187/respcare.05030
DO - 10.4187/respcare.05030
M3 - Editorial
C2 - 27899531
AN - SCOPUS:85026820429
SN - 0020-1324
VL - 62
SP - 1
EP - 9
JO - Respiratory care
JF - Respiratory care
IS - 1
ER -