Preventing Readmission With COPD: Transition From Acute to Home Care
Presented by Kenneth L. Miller, Rebecca Crouch, and Ellen Hillegass
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Readmission to the hospital for patients with COPD is a national concern. It is a problem for hospitals because it comes with a penalty from CMS if the readmission occurs within 30 days of discharge. Patients with COPD require monitoring beyond the acute care setting, and the current evidence supports continued monitoring of these patients beyond the acute care setting and the acute exacerbation. However, transition from the acute care setting to the home (or outpatient setting) is not always smooth, and communication is often lacking. This course will discuss the problem of readmission and transition of care, as well as the patient with COPD who is treated in the acute care setting and moves to the home setting. The identification of COPD patients at high risk for readmission will be discussed, along with the medications the patients may be sent home with and best practice for care in the home and outside the hospital.
Meet your instructors
Kenneth L. Miller
Dr. Kenneth Miller has been an educator, physical therapist, and consultant for the home health industry for more than 20 years and serves as a guest lecturer, adjunct teaching assistant, and adjunct professor in the DPT program at Touro College in Bay Shore, New York. He has presented at the Combined Sections Meeting of the…
Rebecca Crouch
Dr. Rebecca Crouch has practiced cardiovascular and pulmonary physical therapy in the acute care and outpatient rehabilitation settings, and was a founding member and director of the Duke University pulmonary rehabilitation outpatient program for 30 years. She is now an assistant professor in the Doctor of Physical Therapy…
Ellen Hillegass
Dr. Ellen Hillegass is a physical therapist with APTA board certification in the cardiovascular and pulmonary clinical specialty. She is currently a professor on the core faculty at South College Knoxville and South College Atlanta and is an adjunct professor at Mercer University in Atlanta in the department of physical…
Chapters & learning objectives
1. Overview of the Problem: Readmission and Transition-of-Care Issues
CMS has started to penalize hospitals for patients with COPD who are readmitted within 30 days of discharge. Therefore, hospitals have been searching for ways to prevent readmissions. Identifying high-risk patients and developing post-hospital transition programs have become the norm to assist with decreasing readmissions. The evidence on predictors of readmission is discussed; this evidence lays the foundation for this course.
2. COPD: The Diagnosis, Diagnostic Tests, Symptoms, Medications, and Treatment
The physical therapist must be familiar with the typical pathophysiological characteristics and presentation of the COPD patient. Common tests used for COPD diagnosis are adequate to detect moderate to advanced disease but may not be specific enough to detect early stages of COPD. Common medications exist for the relief of symptoms of COPD, but there are no known curative or preventive medications.
3. Treatment of the Acute Exacerbation in the Acute Care and Home Care Settings
Starting with the case of a patient with an acute exacerbation, discussion centers around the treatment of the patient while an inpatient, including the medical management and physical exercise needed. This section discusses the inpatient experience, up to and including the discharge expectations.
4. Role of Oxygen With COPD
Supplemental oxygen is known to improve survival and quality of life in patients with significant resting and exercise hypoxemia. The benefit of supplemental oxygen is less clear for those with minimal to moderate hypoxemia at rest or with exercise. New evidence addressing oxygen supplementation will be discussed.
5. What About After the Acute Care Admission? What Is the Transition to Home Care?
Many patients discharged home from an acute hospital admission for COPD have exacerbations that are not fully resolved at the time of discharge, which increases the risk of rehospitalization. Transitioning home is a vulnerable time point that requires appropriate handoff of information between practice settings and the patient. Coaching, discharge management, and patient self-management are key to reducing readmissions.
6. Home Care Programs for the Patient With COPD: Best Practice Utilizing the ICF Model
Patient engagement and activation to increase adherence to medication regime, physical activity, smoking cessation, and self-monitoring for decompensation are best practices to reduce re-hospitalization risk. Providing education in self-management of medications, including oxygen and activity level will be explored to reduce rehospitalization risk. Providing education in self-management of medications (including oxygen) and activity level to reduce rehospitalization risk will be explored.
