A Case Manager-Led Pneumonia Care Bundle in a Subacute Rehabilitation Facility.

PURPOSE OF THE STUDY: To evaluate the relationship between a case manager-led pneumonia care bundle at skilled nursing facilities (SNFs) and 30-day hospital readmissions for pneumonia. PRIMARY PRACTICE SETTINGS: The primary practice settings included patients hospitalized with pneumonia at 2 community hospitals between October 2018 and June 2019 and who were subsequently transferred to an SNF. METHODOLOGY AND SAMPLE: A retrospective cohort study was completed comparing patients in the preintervention cohort who received pneumonia standard of care versus patients in the postintervention cohort who received a case manager-led evidence-based pneumonia care bundle at an SNF. From October 2018 to June 2019, patients admitted with pneumonia to 2 community hospitals in Northwest New Jersey were enrolled in the preintervention cohort. Patients admitted with pneumonia from January 2020 to June 2021 were enrolled in the postintervention group. The primary outcome was to reduce 30-day readmission rates for all patients discharged from the hospital to an SNF with pneumonia. RESULTS: Ninety-nine patients were enrolled in the preintervention cohort and 34 patients were enrolled in the postinterventions cohort. Thirty-day readmission rates were lower in the postintervention cohort (24.2% vs. 17.7%). This reduction in readmission rates was clinically significant, demonstrating a 27% reduction for all patients discharged from the hospital to an SNF with pneumonia. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: Individualized pneumonia self-management education can be easily implemented in SNFs to improve quality-of-care outcomes for patients. Our health care system collaborates with several SNFs to decrease 30-day hospital readmission. The pneumonia care bundle includes specific measures to improve the transition of care for patients with pneumonia by decreasing the variability of patient care after discharge from the hospital to an SNF. It was hypothesized that to decrease readmissions from the SNFs, we needed to address the quality of care provided by the SNFs by using a 2-prong approach; education of SNF staff on the pneumonia care bundle, and in-person weekly follow-up visits in the SNF until discharge from the SNF to the patient's home.

Impact of a COPD care bundle on hospital readmission rates.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is one of the leading causes of mortality worldwide and contributes considerably to morbidity and health care costs. In October 2014, the Centers for Medicare and Medicaid Services introduced financial penalties followed by bundled payments for care improvement initiatives in patients hospitalized with COPD. OBJECTIVES: This study seeks to evaluate whether an evidence-based interprofessional COPD care bundle focused on inpatient, transitional, and outpatient care would reduce hospital readmission rates. METHODS: A pre- and postintervention analysis comparing readmission rates after a hospitalization for COPD in subjects who received standard of care versus an interprofessional team-led COPD care bundle was conducted. The primary outcome was 30-day all-cause readmissions; secondary outcomes included 60- and 90-day all-cause readmissions, escalation of pharmacotherapy, interprofessional interventions, and hospital length of stay. RESULTS: A total of 189 subjects were included in the control arm and 127 subjects in the COPD care bundle arm. A reduction in 30-day all-cause readmissions between the control arm and COPD care bundle arm (21.7% vs. 11.8%, P = 0.017) was seen. Similar outcomes were seen in 60-day (18% vs. 8.7%, P = 0.013) and 90-day all-cause readmissions (19.6% vs. 4.7%, P < 0.001). Pharmacists consulted with 68.5% of subjects and assisted with access to outpatient medications in 45.7% of subjects in the COPD care bundle arm. An escalation in maintenance therapy occurred more often in the COPD care bundle arm (22.2% vs. 44.9%, P < 0.001) than the control arm. CONCLUSIONS: An interprofessional team-led COPD care bundle resulted in significant reductions in all-cause hospital readmissions at 30, 60, and 90 days.

Decreasing Hospital Readmissions Utilizing an Evidence-Based COPD Care Bundle.

PURPOSE: Chronic obstructive pulmonary disease (COPD) is a chronic condition that leads to significant morbidity and mortality. Management of COPD hospitalizations utilizing an evidence-based care bundle can provide consistent quality of care and may reduce readmissions. METHODS: This single-center retrospective cohort study evaluated readmission rates in patients hospitalized with a COPD exacerbation. Patients in the pre-intervention cohort received usual care, while patients in the post-intervention cohort received an innovative inpatient COPD care bundle. The bundle focused on optimizing care in five areas: consults, inpatient interventions, education, transitions of care, and after discharge care. RESULTS: In this study, 149 subjects were included in the pre-intervention cohort and 214 subjects were included in the post-intervention cohort. Thirty-day readmission rates were lower in the post-intervention cohort compared to the pre-intervention cohort, 22.4% vs. 38.3% (p = 0.001). A reduction in 60-day and 90-day readmission rates was also observed, 13.7% vs. 40.3% (p < 0.001) and 10.1% vs. 32.2% (p < 0.001), respectively. CONCLUSION: Bundled care is an effective and inexpensive method for institutions to provide consistent and quality care. The findings of this study demonstrate that the implementation of a COPD care bundle is an effective strategy to decrease hospital readmissions.

The Impact of a Home Respiratory Therapist to Reduce 30-Day Readmission Rates for Exacerbation of COPD.

BACKGROUND: In 2015, the Centers for Medicare and Medicaid Services limited payments to hospitals with high readmission rates for patients admitted with COPD exacerbation. Decreasing readmissions in this patient population improves patient health and decreases health care utilization of resources. We hypothesized a COPD disease management program delivered by a respiratory therapist (RT) in the patient's home may reduce readmission rates for COPD exacerbation. METHODS: We performed a pre/post interventional study comparing hospital readmissions for subjects with COPD exacerbation that received standard of care in the home versus an RT-led home COPD disease management program. Subjects discharged home from Atlantic Health System with COPD exacerbation were enrolled in the pre-intervention group. Subsequently, an evidence-based home COPD disease management program was implemented by an RT from At Home Medical in the home. The home COPD Disease Management Program was implemented from April 2017-September 2019, and this served as the post-intervention group. The primary end point was readmission rates at 30 d. Secondary end points included 60-d and 90-d readmission rates. RESULTS: A total of 1,093 participants were included in the study, 658 in the pre-intervention cohort and 435 participants in the post-intervention group. Approximately 22.3% (n = 147) of subjects in the pre-intervention group was readmitted within 30 d of discharge compared to 12.2% (n = 53) in the post-intervention group (P < .001). A reduction in 60-d (33.9% vs 12.0%, P < .001) and 90-d all-cause readmissions (43.5% vs 13.1%, P < .001) was also seen. Participation in the COPD Disease Management Program was significantly associated with decreased 30-, 60-, and 90-d readmission rates adjusting for age, gender, race, ethnicity, and smoking status (odds ratio 0.48 [95% CI 0.33-0.70]; odds ratio 0.26 [95% CI 0.18-0.38]; odds ratio 0.20 [95% CI 0.14-0.27];P < .001, for all 3 readmission rates). CONCLUSIONS: The COPD Disease Management Program is significantly associated with decreased readmission adjusting for demographics and smoking status.