COPD Discharge Bundle Analysis

In the community lead pulmonary rehabilitation, (Linda Nici et al., 2006) says, nurses have shown their effectiveness across many settings around the country. (Griffiths et al. 2001) has produced a study that showed a saving in treatment of £152 for every patient treated by the pulmonary rehabilitation programme. Therefore, if a patient could be treated effectively as an outpatient in the home environment, this could enable the ambulance service to contribute to the referral proses, rather than taking the patient to the hospital for assessment by a Doctor. This would allow critically ill patients accesses to the intensive care

The nursing role in pulmonary rehabilitation includes one on one sessions with patients to cover more in-depth education of the disease process including actual anatomy and physiology of the pulmonary system. After that has been covered then the nurses can focus on causes of COPD, symptoms of the disease and management of them, diet, pulmonary exercise, medications for COPD and compliance issues, and most importantly smoking cessation. The nurses will likely require the patient to give return demonstrations of the medication use and pulmonary exercises such as pursed lip breathing (Mohammadi, Jowkar, Khankeh & Tafti, 2013).

Chronic Obstructive Pulmonary Disease also known as COPD, is one of the third leading cause of death in the United States (National Heart Lung and Blood Institute [NHLBI], 2013a). According to the Centers for Disease Control and Prevention (CDC) (2015) approximately 15 million Americans are affected by COPD, with a morbidity rate of 6.8 million. Data from the CDC from 2011 states that 6.3% of the U.S population suffer from this disease; Florida has the COPD prevalence rate of 7.1% with the highest percentage going to Kentucky with a rate 9.3% as summarized by the COPD foundation (2015). CDC calculated the cost of having COPD as $32.1 billion in 2010 and they expect it to rise to $49 billion by 2020, all for a disease that could be prevented. Additionally CDC has stated the mortality rate has decreased in men in the United States from 57.0 per 100,000 to 47.6 per 100,000 from 1999 to 2010. However, regarding the rate for women, there has not been much change during the same time period. The rate shifted from 35.3 per 100,000 to 36.4 per 100,000 (CDC, 2014).

Studies have found that improvements in hospital discharge planning can dramatically improve the outcome for patients as they move to the next level of care (Alliance, 2016). Moreover, Patients, family caregivers and healthcare providers all play roles in maintaining a patient's health after discharge. And although it's a significant part of the overall care plan, conversely there is a surprising lack of consistency in both the process and quality of discharge planning across the healthcare system (S. Shapperd,

In 2013 readmission following hospital stays for AMI, CHF, COPD or pneumonia the cost for readmissions totaled $7.0 billion, which accounted for 13 percent of the cost for total readmissions in the nation (Fingar & Washington, 2015). The highest readmissions fell with HF, followed by COPD, pneumonia then AMI. Trends from 2009-2013 showed a decrease in the overall hospital Medicare readmissions by an average of 9 percent and this was from these top four diagnosis (Fingar & Washington, 2015). This information came from Healthcare Cost and Utilization Project (H-CUP) which is a group of healthcare data bases. Through technological use of several software tools the data needed for this project was abstracted. This is a perfect example of using technology to improve the processes for healthcare improvement by supplying needed data for analyzing to gain the knowledge for change within the healthcare systems (Fingar & Washington, 2015).

The study began with 32 patients having stages II to IV COPD. They had to meet the criteria pertaining to the Global Initiative for Chronic Obstructive Pulmonary Disease; total lung capacity >120%, (FEV1/FVC) <70%, FEV1 <80%, RV/TLC >140% and >40% of predicted values in stable conditions. Patients were removed from the study if they had asthma, heart failure, orthopedic impairments of the shoulder girdle, recent surgery, past thoracic fractures, pneumothorax, and claustrophobia.

This article reviews the history of Medicare’s Hospital Readmission Reduction Program (HRRP) which began in October 2012. It examines why Medicare and Medicaid initiated the program, clarifies what conditions were originally included in HRRP and analyzes the reasoning behind adding Chronic Obstructive Pulmonary Disease (COPD) to the list of high priority conditions. It also, clarifies what information U.S Centers for Medicare and Medicaid (CMS) take into consideration when calculating readmission rates and points to the fact that high readmission rates could be due to non-hospital factors. The authors review new data that focuses on the potential harm of adding COPD to the list of conditions due to the increased level of patients from lower

The team will navigate patients through the program, resources and pulmonary rehabilitation. The registered nurse will meet with the patient prior to discharge to evaluate and refer them to the appropriate services along with the social worker, which may find alternative way to pay for patients medication and other support services that may be offered. The nurse practitioner and the respiratory therapist will see the patient within 48 of hours upon admission into program. The nurse practitioner and respiratory therapist will evaluate the needs at home and enroll the patient in pulmonary rehabilitation, which will be part of the care offered to all patients. Resources for the patient will consist of a 24-hour hotline for patients who may need to seek medical advice prior to going to the emergency room. Patient will be supplied with emergency medications for home use if symptoms begin to appear. A nurse practitioner will be available to advice the patient in intervention with the emergency medications is indicated and advice if treatment may need to be continued in the emergency room. With the protocols in place for medications, the patient will be seen within 12 hours if use of the emergency medications were taken in the home. The nurse practitioner will update the electronic medical chart of the patient to document

The health care organizations have big opportunity to improve their quality of healthcare service as well as improve life quality of customers through reducing an avoidable readmission. The readmission is defined by Centers for Medicare and Medicaid Service (CMS) “Admission to a subsection hospital within 30 days of a discharge from the same or another subsection hospital” Hoffman, J.H. (2012). Readmissions can be classified four different categories, including (1) Planned readmission which the reason of the readmission is related to the initial admission. For example, reconstructive surgery with subsequent steps or it could be series of treatment such as cancer chemotherapy. (2) Planned but the reason is not related to the initial readmission.

The Center for Medicare and Medicaid Services (CMS) have proposed policies that will penalize healthcare organizations for the increasing readmission rate related to patients who has been diagnosed with Chronic Obstructive Pulmonary Disease (COPD). This readmission policy is part of the CMS Hospital Readmission Reduction Program (HRRP) which was enacted to further address the diminishing quality of health care services and to curb the rising cost of health care services by providing financial incentives to healthcare organization in order to promote gravitation toward Accountable Care Organizations (ACO) or Managed Care Organization (MCO). The main objective of levying reimbursement penalties on healthcare organizations is to move away from the fee-for-service method of reimbursement toward a patient-centric, and disease management approach where healthcare services are coordinated not just in the acute phase of disease, but also in the chronic of phase disease.

History of Present Illness: Mr. Magnuson is a very pleasant 77-year-old gentleman who was previously seen in this office by Elvira Aguila, MD for COPD and hypoxic respiratory failure. He is here today for routine followed up. He was last evaluated in January 2015. Since that time, he states that his dyspnea is worse. He feels that it is related to the weather. He does state that he works around the house, although he does have significant functional limitations because of shortness of breath. His wife also confirms that he is able to do less and less. He has a stable, minimal cough. He is using 4L of oxygen at night as well as, as needed throughout the day. He continues to smoke three to four cigarettes on

Decreasing the rate of hospital readmissions has been targeted as a high priority for United States healthcare reform. Proper discharge planning that utilizes an interprofessional team, while determining appropriate patients that will benefit from such models will go a long way in reducing readmissions, meeting the patients at the level of their needs, meeting a performance measure that has been saddled with discouragement by the staff, and finally opening up access to care of patients otherwise that will have ben occupied with those that did not need or could not use it.

Helping patients stay out of hospitals is not only an important quality improvement objective but also a financial one especially after the advent of Affordable Care Act (ACA). Efforts to improve clinical outcomes and reduce readmissions have been ongoing for several years, but still high readmission rates continue to be an issue for most healthcare organizations. Although many hospital readmissions cannot and should not be avoided, a wide variation in readmission rates across the hospitals nationwide, has led the researchers and Center for Medicare and Medicaid Services (CMS) to believe that hospitals can implement various quality improvement strategies to reduce their readmission rates and improve patient care as a whole. In an effort to reduce readmission rates and achieve better quality outcomes, CMS has started Hospital Readmission Reduction Program (HRRP) under which the hospitals will be penalized by up to 3% of total Medicare reimbursements, for readmission cases within 30 days specifically for conditions like heart attack, heart failure, pneumonia, chronic obstructive pulmonary disease (COPD), and elective hip or knee replacement. The percentage of hospitals receiving a penalty in 2014 was around 64%, which has increased to about 78% in FY 2015 making it a high priority quality improvement concern for healthcare organizations in order to retain their Medicare patients and balance their Medicare reimbursements.

The following databases were reviewed for this systemic review: CINAHL Plus, MEDLINE, ERIC and Cochrance. The following journals were reviewed and information obtained for this systemic review: Nursing Times, Journal of Gerontological Nursing and The American Journal of Nursing. The following expert organizations were reviewed: World Health Organization (WHO) and Centers for Medicare and Medicaid Services (CMS). This systematic review was conducted by searching for “Effective discharge planning; does it decrease hospital readmission rates?”. The search was further limited by information that was published within the last five years and in the United States.

In my current role a President of our integrated care network, one are largest cost outliers in our Medicare cost report was our 30 day readmission rate. The government has defined 30 days as the time period they feel a patient should be not readmitted to a hospital for certain diagnoses. Studies have looked at the groups that have had intervention in terms of discharge planning, and those with no intervention or discharged in a "usual" fashion from an institution. A study in the journal Circulation in 2013 looked at this exact question and found that following certain protocols could reduce the readmission rates in heart failure patients (Bradley, et al., 2013).