Atlantic Health System/At Home Medical, Morris Plains, New Jersey.
Atlantic Health System, Morristown, New Jersey.
Respir Care. 2022 Jun;67(6):631-637. doi: 10.4187/respcare.08125. Epub 2022 Jan 5.
In 2015, the Centers for Medicare and Medicaid Services limited payments to hospitals with high readmission rates for patients admitted with COPD exacerbation. Decreasing readmissions in this patient population improves patient health and decreases health care utilization of resources. We hypothesized a COPD disease management program delivered by a respiratory therapist (RT) in the patient's home may reduce readmission rates for COPD exacerbation.
We performed a pre/post interventional study comparing hospital readmissions for subjects with COPD exacerbation that received standard of care in the home versus an RT-led home COPD disease management program. Subjects discharged home from Atlantic Health System with COPD exacerbation were enrolled in the pre-intervention group. Subsequently, an evidence-based home COPD disease management program was implemented by an RT from At Home Medical in the home. The home COPD Disease Management Program was implemented from April 2017-September 2019, and this served as the post-intervention group. The primary end point was readmission rates at 30 d. Secondary end points included 60-d and 90-d readmission rates.
A total of 1,093 participants were included in the study, 658 in the pre-intervention cohort and 435 participants in the post-intervention group. Approximately 22.3% ( 147) of subjects in the pre-intervention group was readmitted within 30 d of discharge compared to 12.2% ( 53) in the post-intervention group ( < .001). A reduction in 60-d (33.9% vs 12.0%, < .001) and 90-d all-cause readmissions (43.5% vs 13.1%, < .001) was also seen. Participation in the COPD Disease Management Program was significantly associated with decreased 30-, 60-, and 90-d readmission rates adjusting for age, gender, race, ethnicity, and smoking status (odds ratio 0.48 [95% CI 0.33-0.70]; odds ratio 0.26 [95% CI 0.18-0.38]; odds ratio 0.20 [95% CI 0.14-0.27]; < .001, for all 3 readmission rates).
The COPD Disease Management Program is significantly associated with decreased readmission adjusting for demographics and smoking status.
2015 年，医疗保险和医疗补助服务中心（Centers for Medicare and Medicaid Services）限制了因 COPD 加重而住院的患者再次入院率较高的医院的支付款项。降低该患者人群的再入院率可改善患者的健康状况并减少医疗资源的利用。我们假设呼吸治疗师（RT）在患者家中提供的 COPD 疾病管理计划可能会降低 COPD 加重的再入院率。
我们进行了一项前后干预性研究，比较了在家庭中接受标准护理的 COPD 加重患者与由 RT 领导的家庭 COPD 疾病管理计划的患者的住院再入院率。从 Atlantic Health System 出院的 COPD 加重患者被纳入预干预组。随后，由 At Home Medical 的 RT 在家庭中实施了一项基于证据的家庭 COPD 疾病管理计划。家庭 COPD 疾病管理计划于 2017 年 4 月至 2019 年 9 月实施，作为后干预组。主要终点是 30 天的再入院率。次要终点包括 60 天和 90 天的再入院率。
共有 1093 名参与者入组研究，其中 658 名入组预干预组，435 名入组后干预组。在预干预组中，约有 22.3%（147 名）的患者在出院后 30 天内再次入院，而在后干预组中，这一比例为 12.2%（53 名）（<0.001）。还观察到 60 天（33.9%比 12.0%，<0.001）和 90 天全因再入院率（43.5%比 13.1%，<0.001）的降低。调整年龄、性别、种族、民族和吸烟状况后，参与 COPD 疾病管理计划与 30 天、60 天和 90 天再入院率的降低显著相关（优势比 0.48 [95%CI 0.33-0.70]；优势比 0.26 [95%CI 0.18-0.38]；优势比 0.20 [95%CI 0.14-0.27]；所有 3 个再入院率均<0.001）。
调整人口统计学和吸烟状况后，COPD 疾病管理计划与再入院率降低显著相关。
