Preventing Readmission With COPD: Transition From Acute to Home Care

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.