This document describes a randomized controlled trial that examined the impact of a respiratory care practitioner-led disease management (RCP-DM) program on outcomes for patients hospitalized with COPD. Patients in the intervention group received education on COPD self-management prior to discharge as well as follow-up calls, while the control group received usual care. Interim analysis found that the intervention group had significantly more ED visits but fewer ICU admissions compared to the control group. Further analysis is still needed to determine the optimal role of RCP-led management plans in improving COPD patient outcomes following hospitalization.

1. Introduction Patients with COPD often
require repeated hospital admissions and/or
visits to the ED for exacerbations of their lung
disease. It is common for many of these repeat
visits to occur within 30 to 180 days following
discharge from a COPD exacerbation. There
are no data examining the impact of a RCP-DM
transition team to facilitate the hospital discharge
of patients with COPD to the outpatient setting.
Method A prospective, randomized trial conducted
at an urban university hospital. Informed consent was
obtained from adult’s ages 18 to 65. COPD diagnosis
was confirmed by spirometry. Only patients
considered high risk were enrolled. High risk included
one or more of the following: at least one
hospitalization or use of oral steroids for COPD
exacerbation in the last year, or use of home oxygen.
Patients assigned to usual care (non intervention) had
their discharge planning and orders done in the
conventional manner and received a one-page
handout containing a summary of the principles of
COPD. Patients assigned to the RCP-DM arm
(intervention) received referral information for
prescription assistance, pulmonary rehab, sleep
study, overnight oximetry as indicated, and a 1-hour
educational in-service conducted by a respiratory
therapist case manager. Education included
description of COPD and management, observation
with return demonstration of inhaler techniques, a
review and adjustment of COPD medications,
smoking cessation, recommendations concerning
influenza and pneumococcal vaccinations, exercise
regimen, and instruction in hand hygiene. In addition,
each subject received an individualized written COPD
action plan. Finally, follow-up calls at 48-72 hours, 7-
10, 30, 90 and 180 days post discharge occurred for
both groups.
Conclusions
RT driven intervention resulted in
significantly more ED visits but much fewer
ICU admissions. The data suggest that the
intervention may have prompted patients to
seek care sooner and more frequently in the
ED. This data was collected at the interim
analysis. Further analysis at the end of this
study and future studies are needed to
determine the optimal utilization of RT
management plans for patients with COPD
following hospitalization in order to improve
their outcomes.
Use of a Respiratory Care Practitioner Disease Management (RCP-DM) Program for Patients Hospitalized with COPD;Interim Analysis
Kidder, R., BA, RRT, AE-C; Clinkscale, D.,MBA; Kollef, M., MD; Watts, P., MS, RRT; Eads,B., RRT, AE-C, Bennett, D, BA, RRT, Lora, C., RRT; Quartaro, M., RRT; Barnes-Jewish Hospital, St.
Louis, Missouri
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Disclosures- There are no conflict’s of interest
Funding: This study is funded by the American Association for
Respiratory Care
Figure 3.a. ICU visits for COPD exacerbations were not statistically different
between the groups. P=0.102. Figure 3.b. ICU visits for reasons other than
COPD were statistically different between the groups=0.046
Figure 3.a Had >=1 ICU Stay, for COPD
No Yes Total
No Interventions 91.3% 8.7% 100.0%
Interventions 96.5% 3.5% 100.0%
All Subjects 93.9% 6.1% 100.0%
Percent of Row
Figure 3.b >=1 ICU Stay, Other reason
No Yes Total
No Interventions 91.3% 8.7% 100.0%
Interventions 97.3% 2.7% 100.0%
All Subjects 94.3% 5.7% 100.0%
Percent of Row
Figure 2.a. ED visits for COPD exacerbations were not statistically different
between the groups. P=0.268. Figure 2.b. ED visits for reasons other than COPD
were not statistically different between the groups=0.064.
Figure 2.a Had >=1 ED Visit, for COPD
No Yes Total
No Interventions 85.2% 14.8% 100.0%
Interventions 79.6% 20.4% 100.0%
All Subjects 82.5% 17.5% 100.0%
Percent of Row
Figure 2.b Had >=1 ED Visit, other reason
No Yes Total
No Interventions 83.5% 16.5% 100.0%
Interventions 73.5% 26.5% 100.0%
All Subjects 78.5% 21.5% 100.0%
Percent of Row
Results 302 patients were enrolled at the time of the interim analysis(152 intervention, 150
control). The number of ED visits was statistically greater in the intervention patients (40.7% v.
26.1%, p = 0.018). Hospital readmissions were similar between the groups (53.1% v. 53.9%, p =
0.902). The overall hospital LOS was similar between intervention and control groups (mean, 7.19
d v. 8.03 d, p = 0.499) as was the ICU LOS (mean, 0.35 d v. 1.28 d, p = 0.216). The number of
ICU admissions was statistically less among intervention patients (6.2% v. 15.7%, p = 0.033).