Since the Centers for Medicare and Medicaid Services began assessing financial penalties for excessive chronic obstructive pulmonary disease readmissions, many hospitals have been struggling to reduce their readmission rates. That has led to new approaches, and here are two that other healthcare systems have found to be successful.
Home management program
Researchers at Atlanta-based Barnes Healthcare Services recently conducted a study to see if a patient management program that included non-invasive ventilators and in-home care would reduce readmission rates for patients with COPD. The study, which was co-authored and funded by Royal Phillips and published in the Journal of Sleep Medicine, examined 397 patients who had all been hospitalized at least twice in a single year with an acute COPD exacerbation. Each patient was prescribed a ventilator for home use. Continued in-home care consisted of medication management, oxygen therapy, patient education and ongoing respiratory therapist care in the home.
Within one year, the proportion of COPD patients who were readmitted on two or more occasions decreased from 100% (397 of 397) to 2.2% (9 of 397).
“This study holds promise in how a multifaceted intervention could assist health systems in significantly improving the care of the patients with advanced stage COPD in their home,” Dr. Sairam Parthasarathy, professor of medicine and director of the Center for Sleep Disorders at Banner – University Medical Center Tucson, said in a statement. “The results indicate that patients placed on this advanced mode of non-invasive ventilation, combined with an in-home care program, can reduce hospitalizations and subsequently reduce healthcare utilization. This study is a good foundation to build from and to further validate.”
Comprehensive disease management program
With the help of a Beacon Community grant that was funded through the American Recovery and Reinvestment Act, Carolinas HealthCare System conducted a comprehensive disease management pilot program in an attempt to reduce COPD admissions. The program focused on continuous identification and follow-up of patients with COPD. It included the following strategies:
- Building health information exchanges and expanding IT capabilities in both inpatient and outpatient settings
- Conducting a root cause analysis on COPD readmissions
- Booking follow-up appointments for ED emergency department (ED) patients
- Providing ED patients with disease management education by respiratory therapists
- Identifying COPD patients on admission and assigning them case managers and respiratory therapists for the duration of their stay
- Assigning inpatients a medical home
- Educating inpatients on disease management and proper use of inhalers
- Scheduling follow-up appointments within two to seven days of hospital discharge
- Making follow-up calls to patients within 48 hours of discharge and as needed for up to 90 days
- Adding respiratory therapists to the staff at physician practices with the highest numbers of COPD patients
During the program, the COPD readmission rate at Carolinas HealthCare dropped from 21.8% to 13% over a three-year period. Dr. Jean Wright, vice president of innovation at Carolinas HealthCare, told Healthcare Financial Management that organizations should start to reduce their COPD readmission rates by focusing on just three to five strategies so they do not become overwhelmed.
“Of all the metrics around readmissions, organizations will feel COPD most acutely because they are not prepared,” she said. “It’s a challenging population, and many organizations don’t know how much of their readmissions are being driven by COPD.
“In the future, we are all going to use more predictive analytics to determine which patients will likely come back to us. Our therapies, interventions and programs like pulmonary rehab will be more targeted,” she said.