title: A Respiratory Therapist Disease Management Program for Subjects Hospitalized With COPD.
abstract: BACKGROUND
  Patients with COPD often require repeated emergency department visits and hospitalizations for COPD exacerbations. Such readmissions increase health-care costs and expose COPD patients to the added risks of nosocomial infections and increased mortality.
  
  
  METHODS
  To determine whether a respiratory therapist (RT) disease management program could reduce re-hospitalization and emergency department visits, a prospective, single-center, unblinded, randomized trial was performed.
  
  
  RESULTS
  We enrolled 428 subjects (214 intervention, 214 control). The primary outcome (combined non-hospitalized emergency department visits and hospital readmissions for a COPD exacerbation during the 6-month follow-up) was similar for the study groups (91 vs 159, P = .08). When the 2 components of the primary end point were analyzed individually, the percentage of subjects with non-hospitalized emergency department visits for COPD exacerbations was similar between groups (15.0% vs 15.9%, P = .79). Readmission for a COPD exacerbation was significantly lower in the intervention group (20.1% vs 28.5%, P = .042). The median (interquartile range) duration of hospitalization for a COPD exacerbation was less for the intervention group (5 [3-11] d vs 8 [4-18.5] d, P = .045). In-patient hospital days (306 d vs 523 d, P = .02) and ICU days (17 d vs 53 d, P = .02) due to COPD exacerbations were significantly less for the intervention group. Mortality was similar for both groups (1.4% vs 0.9%, P > .99).
  
  
  CONCLUSIONS
  Our RT disease management program was associated with less readmission, fewer ICU days, and shorter hospital stays due to COPD exacerbations. Further studies are needed to determine the optimal utilization of RT disease management teams for patients with COPD to optimize outcomes and prevent return hospital visits. (ClinicalTrials.gov registration NCT01543217.).
authors.affiliation: Department of Respiratory Care Services, Barnes-Jewish Hospital, St. Louis, Missouri.
authors.forename: Patty C
authors.initials: PC
authors.lastname: Silver
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St Louis, Missouri. kollefm@wustl.edu.
authors.forename: Marin H
authors.initials: MH
authors.lastname: Kollef
authors.affiliation: Department of Respiratory Care Services, Barnes-Jewish Hospital, St. Louis, Missouri.
authors.forename: Darnetta
authors.initials: D
authors.lastname: Clinkscale
authors.affiliation: Department of Respiratory Care Services, Barnes-Jewish Hospital, St. Louis, Missouri.
authors.forename: Peggy
authors.initials: P
authors.lastname: Watts
authors.affiliation: Department of Respiratory Care Services, Barnes-Jewish Hospital, St. Louis, Missouri.
authors.forename: Robin
authors.initials: R
authors.lastname: Kidder
authors.affiliation: Department of Respiratory Care Services, Barnes-Jewish Hospital, St. Louis, Missouri.
authors.forename: Brittany
authors.initials: B
authors.lastname: Eads
authors.affiliation: Department of Respiratory Care Services, Barnes-Jewish Hospital, St. Louis, Missouri.
authors.forename: Debbie
authors.initials: D
authors.lastname: Bennett
authors.affiliation: Department of Respiratory Care Services, Barnes-Jewish Hospital, St. Louis, Missouri.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Lora
authors.affiliation: Department of Respiratory Care Services, Barnes-Jewish Hospital, St. Louis, Missouri.
authors.forename: Michael
authors.initials: M
authors.lastname: Quartaro
mesh_terms: D019468:Disease Management; D018450:Disease Progression; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D063886:Patient Discharge Summaries; D010353:Patient Education as Topic; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy*; D012138:Respiratory Therapy / Q000379:methods*; D013689:Telephone
keywords: chronic obstructive pulmonary disease; disease management; hospital readmission