This document discusses utilizing respiratory therapists to help reduce hospital readmissions for COPD patients through improved discharge processes and post-care management. It notes that COPD is a leading cause of hospital admissions and readmissions. Respiratory therapists are uniquely trained to assist physicians in classifying COPD severity, educating patients on self-management, and developing action plans to reduce risks and readmissions. Case studies showed that when respiratory therapists serve as COPD case managers in hospitals and clinics, patient outcomes improved, readmissions decreased, and healthcare costs were reduced.

1. © Aurora Health Care, Inc.© Aurora Health Care, Inc.
By Laura Kranitz RRT CPFT
Respiratory Care Practitioners
As A Health Care Resource
A Vision for the Future Care
of Our COPD Patients.
An Investigation of the
Opportunity for Utilizing
Respiratory Therapists in the
Hospital and Clinic Settings to Aid
the Discharge Process of Our
COPD Patients Leading to
Improved Post Care Management,
Decreased Hospital Admissions
and Reduced Health Care Costs

2. © Aurora Health Care, Inc.
General Background
• According to the COPD Foundation
– Chronic Obstructive Pulmonary Disease
(COPD)
– Is an umbrella term used to describe
progressive lung diseases including
emphysema, chronic bronchitis, refractory
(non-reversible) asthma and some forms of
bronchiectiasis
– In 2015 CMS to reduce IPPS
reimbursements to hospitals with excessive
COPD readmissions

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COPD Statistics
According to the CDC:
• 70% of the 24M US COPD patients are
under the age of 65.
– Of those ½ are undiagnosed
• % of WI Adult Population with COPD
– Age Groups:
• 45-54 = 6.2%
• 55-64 = 7.1%
• 65-74 = 11.4%
• > 75 = 9.1%

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Data from the COPD Foundation COPD
Readmissions Summit October 11, 2013
• Over 800,000 hospital admissions per year
are from COPD
• About 20% of hospitalized patients with COPD
are readmitted within 30 days.
• Another 3.8 M stays included COPD as a
secondary or complicating condition.
»1 in 5 hospitalized individuals over
age 40 has a diagnosis of COPD

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COPD Foundation Physician Survey
• 61.1% of PCPs consider
their COPD education
exposure inadequate
• 64.4% of PCPs value
clinical practice
guidelines to help guide
clinical practice.
• 44.9% of PCPs are
unaware of the current
COPD clinical practice
guidelines.

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The Global Initiative for Chronic
Obstructive Lung Disease (GOLD)
• Developed in 1998 with the
WHO, NIH and National
Heart, Lung and Blood
Institute.
• Evidence based clinical
practice guidelines updated
for 2014.
• Provides standardized
treatment and medication
recommendations based on
the latest scientific studies.

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The Global Initiative for Chronic
Obstructive Lung Disease (GOLD)
• Classifies COPD patients into four groups
based on
– Symptoms
– Degree of airflow limitation (using spirometry)
– Risk of exacerbation
– Comorbidities
• GOLD requires a spirometry in the presence
of a post bronchodilator to provide a clinic
diagnosis of COPD.
• “All health care workers who care for COPD
patients should have access to spirometry”

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How Can Respiratory Therapists Help
Reduce Hospital Readmissions?
• They are uniquely trained to assist physicians
in both the inpatient and outpatient settings.
• In the hospital RTs can:
– Assess patients per protocol to GOLD
classifications including spirometry.
– Become valuable members of a multidisciplinary
discharge planning team as soon as patient is
admitted. (MD,RN,RT, SW, CM, PT/OT)
– Educating patients and caregivers on the disease,
use of medications and various DME devices prior
to discharge.

9. © Aurora Health Care, Inc.
How Can Respiratory Therapists Help
Reduce Hospital Readmissions?
• In the clinic RTs can:
– Assist PCPs by classifying the severity of patient’s
COPD per GOLD using spirometry.
– Perform hospital follow up visits that include:
• Patient and caregiver education on the disease process
and use of various inhalers and medications.
• Develop with the patient their personal COPD Action plan
• How to avoid risks by reviewing smoking cessation and
vaccinations and oxygen therapy
• Referrals for out patient pulmonary rehab.
• Document, monitor and improve outcomes
• Develop a care team between the PCP,RN,
patient, family and RT.

10. © Aurora Health Care, Inc.
Use Trained, Experienced Respiratory Care
Practioners (RCP) – Clinical Specialists
• NBRC Registered Respiratory Therapist
(RRT)
• AARC COPD Certified Educator
• NAECB Asthma Educator (AE-C)
• Health Science Related Bachelor Degree
HR 2619 Medicare Respiratory Therapist
Access Act of 2013
 It will amend Medicare Part B to provide
coverage of pulmonary self-management
education and training by a qualified RCP in
the physician practice setting.

11. © Aurora Health Care, Inc.
UC Davis Health System Using RCPs as COPD
Case Managers –Results of Two Year Study
Received a grant from the University of California

12. © Aurora Health Care, Inc.
How Can Hospitals Reduce Readmissions?
American Hospital Association (AHA) Recommendations
• Focus on avoidable hospitalizations
• Enhance discharge planning
• Partner with post-acute care providers
– Aurora Medical Center Grafton
– Aurora Advanced Healthcare
• Use health care personnel with advanced training to provide
disease specific patient education.
• Develop a high-risk patient readmission tool using the evidence
based GOLD 2014 guidelines.
• Appoint a discharge advocate to schedule PCP follow up visits
and follow up telephone calls.
• Develop personalized COPD Action plans, teach self-
management and make referrals to pulmonary rehab.

13. © Aurora Health Care, Inc.
References
• Global Initiative for Chronic Obstructive Lung Disease, 2013 (WHO, NIH
and National Heart, Lung and Blood Instittute)
• COPD Management, Avoiding Readmissions Due to Acute
Exacerbations, RT Magazine, October 2013 (part 1), November, 2013
(part 2) by Timothy Op’t Holt, EDD, RRT, AE-C FAARC
• Reducing COPD Readmissions, Webinar 4/28/2014 RT Magazine
– Deb McGowan COPD Foundation (Carolinas Healthcare System (CHS)
– Samual Loue