Focus on COPD Outcomes

Hospitals and medical centers are beginning to see the value of using evidence-based practice guidelines and care transition protocols in improving the health of patients with chronic obstructive pulmonary disease (COPD).

One of the keys to better care is giving respiratory therapists a bigger role in improving the quality of COPD outcomes to reduce rates of hospital readmission and curb disease recurrence.

“There is factual evidence that respiratory therapists can make a difference in the lives of COPD patients,” stated Patrick J. Dunne, MEd, RRT, FAARC, HealthCare Productions, Inc., and a former president of the AARC.

In 2010, Dunne observed a program at Sanford Health Medical Center, in Fargo, ND, that completely reversed its standard of care for patients with COPD. The medical center assembled an interdisciplinary COPD team tasked with standardizing inpatient care for patients with COPD using evidence-based guidelines. The result was a dramatic reduction in hospital readmission rates, a common issue with this patient population.

Better outcomes for COPD, the third leading cause of death and the fourth leading cause of hospital readmissions in the United States, will significantly improve the outlook for patients and the institutions providing care.

“Sanford paved the way in this area and now there are numerous COPD algorithms and standards of care available in the industry to help reduce the drain on healthcare resources,” Dunne said.

Respiratory Therapy at the Forefront of Care
COPD is an umbrella term used to describe progressive lung diseases including emphysema, chronic bronchitis, refractory (non-reversible) asthma, and some forms of bronchiectasis, according to the COPD Foundation. Caring for patients with this chronic disease presents many obstacles.

“One problem hindering COPD management is the lack of research,” Dunne explained. “When faced with a finite amount of resources, relying on evidence-based guidelines is the way to go.”

Respiratory therapists need to advocate for evidence-based medicine as the standard of care in the treatment of COPD. “There is, of course, some pushback from therapists who say ‘we aren’t prescribers,'” Dunne observed. “However, RTs are knowledgeable, and are good influencers and recommenders.”

Improving COPD outcomes is a professional passion for Dunne, who had direct experience working with hundreds of COPD patients in the 20 years he spent as a homecare RT. He also points to two individuals who guided the industry to improve the care provided to COPD patients.

His inspiration first came from Thomas L. Petty, MD, a world-renowned pulmonologist from Denver, who took the medical community to task for ignoring COPD patients. Dunne continues to be inspired by John Walsh, Founder and President of the COPD Foundation, who recognized the huge impact of COPD, but found that research investigating new treatments and knowledge of the disease was abysmal.

SEE ALSO: Combatting COPD Readmissions

Inspiring Change in the COPD Treatment Map
Dunne feels strongly that respiratory therapists are in a great position to provide physicians, specialists and those in primary care with the evidence-based care guidelines to close the monumental gaps in COPD care. “In this day and age of poorly managed COPD care, I see therapists as ‘gap closers,’ working on the frontline with physicians, families, patients and home care specialists.”

According to Dunne, respiratory therapists have a chance to go beyond simply administering treatments to provide patient better care under the guidelines of the ACA. One of the biggest gaps in care happens when a patient steps off campus because the healthcare provider doesn’t have control over what happens at home.

“CMS’s newer philosophy is that they are compensating you (the hospital) to take care of a patient’s condition,” Dunne said. “So, we need to close those gaps that impede the attainment of improved outcomes.”

A patient’s behavior once she leaves the hospital can clearly have adverse effects on her health, and could potentially drain the resources of the health system. RTs are in a position to help hospitals accept their role in care transition.

RTs can facilitate the transition of patients from one setting to the next, and communicate with the home care company to bridge the care. “Hospitals need to change the approach so the team is preparing patients for a successful discharge from the time they are admitted,” Dunne said.

Dunne points to Eric Coleman’s four pillars of effective transition care รป as the cornerstone of COPD management. “The transition of care is critical because patients are historically not properly prepared for self-care management,” he stated. The four pillars include:

Medication reconciliation to ensure the right controller medications are is prescribed with the right delivery device. “Patients need to have an understanding on why they are taking a particular medication, and what happens when they stop taking it,” Dunne shared.

Red flag warnings, such as increasing shortness of breath, coughing more frequently and changes in mucus can signal the onset of a relapse. “We want patients to access their physicians sooner rather than later,” Dunne said. “COPD patients tend to deny they are getting sick, and then they land in the ED and eventually get re-hospitalized. Patients need to know who to call and when.”

Immediate follow-up visits with physicians after hospital discharge are important. According to Dunne, these appointments should be in the first 5 to 7 days. “Physicians are then able to conduct an evaluation of how well their patients are doing to help eliminate problems down the line,” he explained.

Provide patients and families with a comprehensive and comprehendible written care plan. “The patient has to be at the center of the care plan to control symptoms and, most importantly, avoid the relapse to smoking,” Dunne stated.

“There is factual evidence that [RTs] can make a difference in the lives of COPD patients.”

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Technology & Telehealth

With the advent of wearable devices, smart phone applications and telemedicine, it’s easier than ever to interact with and better care for this chronic patient population. “Telehealth is an explosion in the industry that is taking off,” Dunne explained. “The evidence is there, telehealth can help.”

According to Dunne, a recent Kaiser Permanente study found COPD patients who report 30 minutes of exercise five days a week have a 30% lower rate of hospital readmission. He believes wearable devices are key to keeping patients moving, however, COPD patients are by and large not a part of the app-savvy population.

To be clear, Dunne qualified that telehealth is a complement to care. “It’s not replacing the face-to-face interactions but rather enhancing and extending them,” he relayed. “It’s about getting patients engaged and on a sustained schedule and regimen, all of which is critical to the COPD patient’s health.”

Rebecca Mayer Knutsen is on staff. Contact:

Coleman, E. A., Smith, J. D., Frank, J. C., Min, S.-J., Parry, C. and Kramer, A. M. (2004), Preparing Patients and Caregivers to Participate in Care Delivered Across Settings: The Care Transitions Intervention. Journal of the American Geriatrics Society, 52: 1817-1825.

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