Chronic obstructive pulmonary disease, or COPD, is a progressive lung disorder characterized by the constriction or narrowing of the respiratory passages. According to the American Lung Association, COPD is a leading cause of morbidity and mortality in the United States, with more than 12.5 million people diagnosed with the disease. Another study found that 22.6% of patients hospitalized for COPD in the U.S. were readmitted within 30 days of discharge.
Reducing readmissions for patients with COPD can be challenging, but there are proven ways for healthcare providers to make a difference. This blog post will discuss well-researched strategies for reducing COPD readmissions and improving patient outcomes.
In one study, researchers found that remote patient monitoring intervention decreased the frequency of all-cause hospitalizations for participating COPD patients by 65%, decreased emergency room visits by 44.3%, and most patients adhered to RPM program requirements 90% or more during the 12-month post-initiation period.
Before we dig into this and other strategies for reducing readmissions, let's explore the risk factors that contribute to re-hospitalization rates.
Risk Factors for COPD Readmission
A better understanding of risk factors associated with COPD exacerbation is critical to managing high readmission rates effectively. Clinicians must determine appropriate interventions to ensure a reduction in disease exacerbation.
Comorbidities
It is common for patients suffering from COPD to be diagnosed with other comorbidities such as cardiac disease, diabetes mellitus, hypertension, osteoporosis, and psychological conditions. A study revealed that comorbidities are seen in almost all COPD patients, with 88% reporting at least one other disease.
Lung function
COPD causes the airways in the lungs to thicken and become inflamed. This leads to the tissue where oxygen exchanges happen to be destroyed, and the airflow in and out of the lungs decreases. In severe cases, it causes permanent damage to the lungs.
Hypercapnic respiratory failure
Hypercapnia is the buildup of carbon dioxide in the bloodstream. Inflamed airways and damaged lung tissue in COPD patients make breathing in oxygen and breathing out carbon dioxide difficult. High carbon dioxide concentration in the blood changes the pH balance, making it too acidic, and this may lead to kidney failure.
Nutritional status and body mass index
Malnutrition is common among COPD patients and significantly worsens the severity of the condition. Healthcare providers must assess each patient’s overall nutrition status so that proper treatment can be administered.
Physical frailty and sarcopenia
Physical frailty and sarcopenia are reflected by skeletal muscle dysfunction and are usually associated with the aging process. In COPD patients, the prevalence of both frailty and sarcopenia increases with age, disease severity, symptoms, and other comorbidities.
Social Determinants of Health
Social determinants of health (SDoH), including low income, lack of transportation, and lack of home safety can increase the risk of COPD exacerbations. For example, people of low socioeconomic status are more prone to tobacco use and occupational hazards, such as exposure to inhalant toxins and indoor biomass fuel.
Strategies to Reduce COPD Readmissions
Clinical service strategies and care bundles
The high rates of hospital readmissions lead to substantive clinical and economic strain on the healthcare system. It is crucial for healthcare providers to implement evidence-based strategies to reduce readmissions. To bridge the post-discharge care gap, providers can consider empowering patients to practice self-care and introducing discharge care bundles.
Self-management plans
A well-structured self-management plan allows COPD patients to follow their medical regimens and change their unhealthy behaviors independently. Lifestyle changes and coping techniques such as quitting smoking and, adhering to medication schedules and recommended diet can be employed to manage the symptoms. Patient education is key here. Healthcare practitioners can leverage telehealth and remote patient monitoring (RPM) to engage patients post-discharge and promote behavioral change through tools such as teach-back videos and teleconsultations.
COPD care plans and discharge bundles
The Institute for Healthcare Improvement defines discharge care bundles as a set of evidence-based practices proven to improve patient outcomes when practiced collectively and reliably. For COPD patients, the care bundle may include patient-specific care plans and a self-management guide, a demonstration of inhaler techniques, referral to a smoking cessation program, assessment for pulmonary rehabilitation, and arrangement for outpatient follow-up. Personalized care plans and discharge bundles promote better patient engagement.
Hospital at Home
The Hospital at Home program enables patients to receive hospital-level care in the comfort of their homes. Thanks to telehealth and RPM, healthcare practitioners can confidently administer care remotely. Real-time tracking of a patient's condition and making swift decisions about what should be done allow them to manage treatment and adherence with peace of mind.
5 Lessons Learned About Hospital at Home Programs
We interviewed two Hospital at Home program leaders at Michigan Medicine and Allina Health who provided helpful insights into their Hospital at Home programs and shared their lessons for success.
General frameworks for reducing readmissions
Several evidence-based frameworks that are not disease-specific have proven effective in reducing hospital readmissions. These general frameworks include Project Re-Engineered Discharge (RED), Project Better Outcomes for Older Adults through Safe Transitions (BOOST) and Transitional Care Model.
Project RED
Developed by a research group at Boston University Medical Centre, this project is focused on improving the discharge process to promote patient safety and reduce readmissions. RED consists of 12 components: language assistance, accurate medication plan and adherence, patient education, follow-up plans, etc.
Project BOOST
Recommended by the Centers for Medicare and Medicaid Services (CMS), BOOST has been used for care transition in more than 200 hospitals across the U.S. and Canada since 2008. The program is designed to reduce preventable readmissions by improving provider workflow, reducing medication-related errors, and empowering patients and their caregivers.
Transitional Care Model
The Transitional Care Model, developed by the Lexington Medical Center in West Columbia, aims to equip patients with the necessary tools to manage their disease post-discharge. Patients are given a COPD Toolkit with a folding bag containing inhalers, a weekly pill holder, an MDI spacer, a pulse oximeter, and an Action Plan magnet. They are also given an education book that contains information on their disease, inhaler descriptions with photos, and information on smoking cessation.
How Telehealth and RPM Can Help
HRS’ turnkey remote COPD monitoring solutions help reduce readmissions, improve compliance, and increase patient satisfaction by providing effective virtual care. Healthcare practitioners can leverage our telehealth and RPM programs for symptom surveys, patient education, and vital sign monitoring.
