Chronic Obstructive Pulmonary Disease Education and Training by Respiratory Care Practitioners Decreases Healthcare Utilization and Improves Patient Outcomes

Abstract

PURPOSE: Hospital admissions and readmissions to the UC Davis Medical Center (UCDMC) for Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD) have increased since 2009 and represent an opportunity for multidisciplinary chronic disease management. In fiscal year (FY) 2011, average length of stay (LOS) for AECOPD was 7.57 days; readmission rate within 30 days after discharge was 16%. A COPD case management team was instituted March 2012 with the goal of intensifying patient education and streamlining patient access to primary and subspecialty services. METHODS: Seven RCP COPD Case Managers under the supervision of a pulmonologist, provided inpatient COPD education utilizing a written COPD Action Plan individualized for each patient that incorporated Global Initiative for Chronic Obstructive Lung Disease (GOLD) treatment guidelines. Four inpatient education sessions included anatomy and physiology of the respiratory system, proper inhalation device use, return demonstration, controlled breathing techniques, infection control, referral services, and medication reconciliation. At discharge, each patient was given continued access to the case manager on duty through a telephone pager. RESULTS: Between March 2012 and February 2013, 75 AECOPD patients were hospitalized: 41 (55%) were women, mean age was 69 years (range 46 to 88 years), 36% had very severe Grade IV COPD, 44% had severe Grade III COPD, 17% had moderate Grade II COPD, and 4% had mild Grade I COPD. Employing RCP COPD case management, average LOS for AECOPD was reduced by 1.9 days to 5.7 days for a projected cost savings of $6,511 per admission. Readmission rate was reduced from 16% in FY 2011 to 5% with projected cost savings of $481,814 during study period. CONCLUSIONS: RCP COPD Case Managers are effective in reducing hospital LOS and readmission for AECOPD