Video Telehealth Pulmonary Rehabilitation Intervention in Chronic Obstructive Pulmonary Disease Reduces 30-Day Readmissions

• Published in: American journal of respiratory and critical care medicine 2019-08, Vol.200 (4), p.511-513
• Main Authors: Bhatt, Surya P, Patel, Siddharth B, Anderson, Erica M, Baugh, Daniel, Givens, Tina, Schumann, Christopher, Sanders, J Gregory, Windham, Samuel T, Cutter, Gary R, Dransfield, Mark T
• Format: Article
• Language: English
• Subjects: Aged; Breathing Exercises; Chronic obstructive pulmonary disease; Clinical trials; Correspondence; Disease management; Exercise; Female; Health care policy; Humans; Intervention; Kaplan-Meier Estimate; Male; Middle Aged; Mobile Applications; Muscle Stretching Exercises; Patient admissions; Patient Readmission - statistics & numerical data; Physical fitness; Proportional Hazards Models; Pulmonary Disease, Chronic Obstructive - rehabilitation; Rehabilitation; Resistance Training; Smartphone; Smoking cessation; Telemedicine; Telerehabilitation - methods; Videoconferencing
• ISSN: 1073-449X; 1535-4970
• DOI: 10.1164/rccm.201902-0314LE

Potential participants were identified by means of a daily hospital census, and patients were approached for enrollment irrespective of disease severity, except for those with unstable arrhythmias, congestive heart failure with a left ventricular ejection fraction of 5 L/min at rest, or other comorbidities that precluded participation in exercise, including orthopedic conditions and severe dementia. All participants received a comprehensive bundled care for readmission reduction during hospitalization and after discharge that was comprised of a uniform duration of 5 days of systemic steroids and antibiotics, disease management education, follow-up in the COPD clinic within 10 ± 2 days, smoking cessation counseling when applicable, home health or palliative care when suitable, and referrals to traditional PR (2). Baseline Characteristics of Patients in the Video Telehealth Pulmonary Rehabilitation and Unexposed Arms Telehealth PR (n = 80) Unexposed (n = 160) Age, yr 64.5 (10.1) 63.4 (11.8) Sex, F 49 (61.3%) 92 (57.5%) Race, African American 26 (32.5%) 57 (35.6%) Body mass index, kg/m2 29.0 (10.2) 28.2 (8.2) Current smoker 21 (26.3%) 60 (37.5%) FEV1% predicted* 45.4 (18.1) 48.6 (21.1) FEV1/FVC* 0.52 (0.15) 0.57 (0.15) Domiciliary oxygen use 43 (53.8%) 44 (27.5%) Coronary artery disease 16 (20.0%) 31 (19.4%) Atrial fibrillation 8 (10.0%) 13 (8.1%) Congestive heart failure 10 (12.5%) 24 (15.0%) Hypertension 55 (68.8%) 111 (69.4%) Diabetes mellitus 22 (27.5%) 46 (28.8%) Depression 16 (20.0%) 40 (25.0%) Anxiety 15 (18.8%) 32 (20.0%) Hospitalizations in prior 12 mo 0.9 (1.4) 0.9 (1.7) ER visits in prior 6 mo 1.0 (1.5) 0.7 (1.4) Length of stay, d† 4 (2) 4 (3) LACE index 10.7 (2.8) 10.6 (3.0) Definition of abbreviations: ER = emergency room; LACE = length of stay, acuity of admission, comorbidities, and ER visits in the previous 6 months; PR = pulmonary rehabilitation. A retrospective study of a comprehensive care plan comprised of smoking cessation and inhaler education; pulmonary consultation; comorbidity assessment; palliative care assessment; mucus clearance device and inhaler selection based on clinical assessment of patient dexterity, competence, and peak inspiratory flow; and close outpatient follow-up showed a 16% reduction in all-cause readmissions (4).