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Reducing COPD Readmission Rates: Using a COPD Care Service During Care Transitions

A chronic obstructive pulmonary disease care service improves timely access to follow-up care and patient education at the time of transition from hospital to home.
Federal Practitioner. 2018 November;35(11)a:30-36
November 5, 2018|Federal Practitioner
Edward C. Portillo, PharmD;Andrew Wilcox, PharmD;Ellina Seckel, PharmD;Amanda Margolis, PharmD;Jean Montgomery, MD;Prakash Balasubramanian, MD;Geri Abshire, MSN, RN;Jim Lewis, RRT;Christopher Hildebrand, MD;Sameer Mathur, MD;Alan Bridges, MD;Sujani Kakumanu, MD
Author and Disclosure Information

Edward Portillo is a Clinical Pharmacist Specialist, Andrew Wilcox is Chief of Pharmacy Services, Ellina Seckel is Acting Chief of Primary Care and Associate Chief of Ambulatory and Specialty Care, Amanda Margolis is a Clinical Pharmacist Specialist, Jean Montgomery is a Physician in Primary Care, Prakash Balasubramanian i s a Hospitalist, Geri Abshire is the Northern Tier Clinic and Nurse Manager-Primary Care, Jim Lewis is Chief of Respiratory Therapy, Christopher Hildebrand is the Associate Chief of Staff for Education and Ambulatory Care, Sameer Mathur is Associate Professor in the Division of Allergy, Pulmonary and Critical Care Medicine, Alan Bridges is Chief of Staff, and Sujani Kakumanu is Chief of Allergy, all at the William S. Middleton Memorial Veterans Affairs Hospital in Madison, Wisconsin. Edward Portillo and Amanda Margolis are Clinical Assistant Professors at the University of Wisconsin-Madison School of Pharmacy. Christopher Hildebrand and Alan Bridges are Clinical Professors in the Department of Medicine, and Sameer Mathur is an Associate Professor at the University of Wisconsin-Madison School of Medicine and Public Health.

Author disclosures
The authors report no actual or potential conflicts of interest with regard to this article.

Disclaimer
The opinions expressed herein are those of the authors and do not necessarily reflect those of Federal Practitioner, Frontline Medical Communications Inc., the US Government, or any of its agencies. This article may discuss unlabeled or investigational use of certain drugs. Please review the complete prescribing information for specific drugs or drug combinations—including indications, contraindications, warnings, and adverse effects—before administering pharmacologic therapy to patients.

Future Directions

Although a major objective of this service was to reduce readmissions 30 days postdischarge, it is possible interventions made in clinic may have long-term beneficial effects.25,29 Future research should evaluate the impact of this interprofessional service on long-term disease outcomes, thereby determining whether the promising readmission results are sustained beyond 30 days postdischarge.30 In addition, incorporation of respiratory therapy and inpatient pharmacists during hospital discharge could provide a more effective and sustainable transition from hospital to home before the COPD CARE clinic visit.

Future implementations and evaluations of this COPD CARE service will in turn benefit from a key component of our intervention, which includes the collection of timely CAT scores, spirometry data, and adherence rates for COPD patients.31 Furthermore, the intervention was successfully delivered to a population recently hospitalized or seen in the ED, and therefore, at high risk for future COPD exacerbations. This initiative provides positive proof of a concept QI project using the existing PACT team model to reduce 30-day readmission rates in patients with COPD at high risk for exacerbation. Future efforts will focus on delivering this intervention to patients with mild, moderate, and severe COPD within a wide range of primary clinics.

Conslusion

The COPD CARE service involved the coordinated postdischarge care facilitated by an interprofessional team of clinical pharmacists, nurses and PCPs. The COPD CARE service leveraged an interprofessional team, centered on the PACT medical home, to make clinic interventions resulting in a 0% readmission rate and 63.2% increase in PCP access. The COPD CARE service further demonstrated the impact of coordinated efforts by interprofessional teams to optimize care for COPD management.

Acknowledgments
The authors thank Stephanie Gruber, PharmD; Lieneke Hafeman, RN; Molly Obermark, PharmD; Julia Peek, RT; Mark Regan, MD; Chris Roelke, RN; Steve Shoyer, PharmD; John Thielemann, RN; Sandy Tompkins, BS; and Wendi Wenger, RN, for their integral roles in the COPD CARE service.

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