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Changes in COPD Treatment

Examining therapy options outside the hospital.

Chronic illnesses put a lot of pressure on healthcare organizations, both in terms of overall patient care and financial penalties. In respiratory departments, patients with COPD or similar illness can end up being readmitted several times, which puts a strain on both the patient and the hospital. As healthcare facilities continue to adapt in an evolving industry, there has been a marked regulatory effort to keep patients out of the hospital to prevent these these hospital stays. Naturally, issues like COPD present significant challenges under new regulatory guidelines regarding readmission rates, but these rates affect non-chronic areas as well.

"Hospitals have a readmission rate for patients admitted for heart failure, myocardial infarction or pneumonia because a lot of those conditions are chronic illnesses," said Adam Benjafield, PhD, vice president of medical affairs at ResMed Corp., in a recent interview with ADVANCE. "And there's a reasonable chance that you could come back to the hospital with a worsening of your condition."

The new changes in readmission regulations from the Center for Medicare and Medicaid Services (CMS) have brought on penalties if a facility exceeds the acceptable limits for a predetermined 30-day readmission rate. These rates apply to the illnesses listed above and in the near future will also include COPD, and readmissions are for any cause not just a worsening of the illness that lead to the original admission. For example, if someone is treated and released after suffering a heart attack, but comes back a couple days later for something non-related like a car accident, this will still count toward overall readmission. These penalties come out of the facility's total CMS benefits, meaning the price for relatively small percentages could still be substantial.

In the case of COPD, different types of ventilation are being introduced in an effort to more effectively treat within the facility, as well as continue therapy efforts outside of the facility when a patient goes home in order to lower readmissions. Benjafield noted noninvasive ventilation (NIV) efforts as a particularly promising area in the treatment of COPD. NIV, which refers to bi-level positive airway pressure, can be used in place of intubating a patient in the hospital, as well as in the evening once that same patient leaves. By incorporating this kind of ventilation as the patient sleeps, Benjafield also pointed out the potential for reduced readmission rates.

"One of the new areas is the use of noninvasive ventilation for chronic hypercapnic COPD. So, there's a few major research studies that are underway," continued Benjafield. "And one whose results will be known later this year, looking whether long-term use of NIV can improve mortality and morbidity in hypercapnic COPD patients."1

A recent press release from PR Newswire2 noted the results of the study1 mentioned by Benjafield have been A recent press release from PR Newswire2 noted the results of the study1 mentioned by Benjafield have been released, and the study has been published in The Lancet Respiratory Medicine.1 The study confirmed several theories on the impact of NIV on chronic hypercapnic COPD patients, demonstrating advances in key factors and symptoms such as blood gas levels, but also validated the use of NIV in improving patient survival.1 Overall, the clinical relevance of the study shows the benefits of using NIV as part of long term care.

While there are still some circumstances that require physicians to intubate a patient, NIV therapies are able to handle many of the scenarios that might otherwise require the highly invasive technique. As a whole, however, the need to intubate a patients is becoming smaller and smaller as more facilities adopt NIV approaches. Between the weaning process, the rehabilitation process and the risk of potentially dangerous infection, the process of intubating can be difficult on the patient and facility alike in terms of safety, finances and operational hurdles associated with it.

"If someone's been intubated, you've got to wean them off the ventilator," explained Benjafield. "You don't just take them off and give them nothing and they're fine because you've been completely mechanically breathing for them for a period of time. So, you sort of need the transition, whereas with noninvasive ventilation, it's much easier to start and stop the therapy."

According to Benjafield, the use of NIV approaches for COPD patients remains somewhat underutilized despite the potential benefits. Although the use of NIV is lower than what might be expected, there has been a large scale movement to educate healthcare providers regarding NIV methods. Education practices such as training camps and simulation training programs for respiratory professionals and departments have helped to spread awareness about the benefits of these approaches. In doing this, healthcare facilities can shift the rate in which NIV techniques are being utilized.

With new treatments, therapies and regulations being continuously introduced, the healthcare industry is changing -- and individual departments along with it. Respiratory is no exception. As a chronic illness, COPD increases the likelihood of patient readmission, highlighting the need to decrease the time a patient spends in the hospital and increase the time spent outside on their own. If NIV therapies allow physicians to keep their patients out of the hospital longer, the need to introduce these methods is vital in maintaining compliance with the new regulations.

Michael Jones is on staff at ADVANCE. Contact at mjones@advanceweb.com

References
1. http://www.thelancet.com/journals/lanres/article/PIIS2213-2600(14)70153-5/abstract
2. http://www.prnewswire.com/news-releases/269807231.html

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Patient compliance accounts for poor outcomes.
Home care should include respiratory therapists follow up.
But the funding is is "iffy" and many of the home health
services will not hire RCPS .
Thanks for allowing my comments!


Esther Pierce,  RRT-Rcp,  Retired active August 27, 2014
Ranger, TX




     

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