Outcomes From the Implementation of a Pulmonary Disease Navigator for Higher Risk Patients: In-Hospital Mortality and 30-day Readmission Rates

Background:

Dixie Regional Medical Center is a 245-bed hospital and one of 23 acute care hospitals of the Intermountain Healthcare Corporation. To improve CMS Core Measures1 for COPD, we instituted a Pulmonary Disease Navigator (PDN). PDN duties include but are not limited to: 1) earlier disease education, 2) creation of documented care plans, 3) transition care management, 4) timely, medically necessary referrals (eg, PFT, pulmonary rehab), 5) post-discharge follow-up phone calls for care plan adherence, 6) medication instructs, 7) training patients on the proper use of CPAP, BIPAP and other equipment, 8) airway clearance methods, 9) breathing exercises, and 10) tobacco cessation and all aspects of symptom management, and 11) interdisciplinary pulmonary care trainings. We sought to identify what, if any, outcomes might be improved with the addition of the PDN.

Methods:

Between May 2017-March 2018, 127 patients were identified as diagnosed with COPD and followed by our PDN. Of these 127, 67 (53%) were admitted with COPD exacerbation. We sought to determine what if any impact the PDN might have on COPD patient care and outcomes.

Results:

Pre- and post-PDN outcomes are reported in Table 1.

Conclusions:

PDN implementation occurred Q3 2016. It is interesting to compare Q2 2016 with Q2 2017 as well as Q4 2016 with Q4 2017 outcomes for both in hospital mortality and 30-day readmission rates. While we cannot conclude an absolute cause and effect relationship solely with the implementation of the PDN implementation Q3 2017, the drop in both outcomes tends to strengthen our suggestion that employing a PDN has impacted outcomes. Detailed outcomes are reported in separate abstracts. Since initial implementation of the PDN, we report other benefits. These include but are not limited to: 1) physicians requesting PDNs in clinics, 2) physicians requesting RRTs as telemedicine consultants, 2) enhanced patient/healthcare team communication, 3) improved timeliness of medically necessary referrals (e. g. , tobacco cessation, PFT, advance care planning), and 4) elevation of Respiratory Therapy as a profession. Patients, families and members of the healthcare team benefit from detailed, timely, coordinated interventions that are best guided by Respiratory Therapists under the general supervision, direction and orders from physicians.

1. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-AssessmentInstruments/HospitalQualityInits/Measure-Methodology.html

Table One: DRMC COPD In-Hospital and 30-Day Mortality All Payer by Quarter