3 steps to saving costs by shifting patients from hospital to home
What’s the key to saving costs in patients with COPD? Shifting care settings. Discover three steps to get patients from hospital to home and cut your institution’s costs in the process.
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Change the setting — change the cost of care
Quality care exists in many different settings. Whether it’s inpatient or outpatient, the goal in treating patients with COPD is always the same: getting and keeping them healthy at home. By delivering quality care in the least expensive care setting—the home—your institution may see a significant savings in cost. While this concept seems simple, shifting patients from hospital to home often proves to be quite challenging and expensive if done incorrectly. So how can you ensure your patient’s transition is seamless? And, what are the most effective ways to keep them from being readmitted? Read on to discover our experts’ three critical steps to save costs by shifting your patients from hospital to home today.
1. Get respiratory therapists involved from the start
Shifting patients from the hospital—the most expensive care setting—to their home takes a team effort. But, one team member plays a key role from the moment a patient is admitted: the respiratory therapist (RT). In order to make your patient’s admission as short as possible, RTs need to practice at the top of their scope. This means: Once RTs have pinpointed potential obstacles, they can educate the rest of the team on how to contribute to getting the patient home sooner. And, with the rest of the team contributing, you can begin to move onto step 2.
Contributors
Respiratory therapists have the highest technical knowledge to serve as a bridge from hospital to home.”
-Jill Ohar, MD, FCCP
Professor of Internal Medicine, Pulmonary, Critical Care, Allergy, and Immunological Diseases Wake Forest University School of Medicine
Director of Clinical Operations
Wake Forest University Baptist Medical Center
On the role RTs play in shifting care
-Becky Anderson, RRT Manager, Respiratory Care Services Sanford Medical Hospital
2. Develop a quality discharge plan
Before any patient leaves your institution, a discharge plan needs to be set. But, not just any discharge plan; your plan needs to be well thought out and tailored to that specific patient’s needs in order to prevent a potential readmission.
Numbers you can’t ignore
More than 40% of patients with COPD end up back in the hospital after three months2
Consider this when developing a discharge plan
Set time aside to speak with your patient and their family
Ask them what barriers to care they face at home and provide patient-centric education on how they may help reduce them before discharge. Education can be in the form of3:
- Medication and/or proper device usage tips
- The importance of remaining physically active
- Helping them plan meals or identifying services that will provide meals for them
Consider this when developing a discharge plan
Assess the patient’s level of risk for exacerbations and readmissions
The GOLD rubric is an invaluable tool that will help you4:
- Classify a patient’s FEV1 levels and COPD stage
- Measure breathlessness with the Modified British Medical Research Council (mMRC) Questionnaire
- Assess other symptoms with the COPD Assessment Test (CATTM)
- Categorize patients to develop an optimal treatment plan for their needs
Consider this when developing a discharge plan
Set contact points with the patient over the first 30-day period post-discharge
Dedicate a specific team member to do this. Depending on the patient’s needs, contact points can be live, in-home visits or over the phone.
Discover how to keep your patients healthy at home with Brian Carlin’s
4 keys to sustainable readmission reduction
3. Maximize their home care — minimize your cost
For patients with COPD, quality care shouldn’t slow down once they shift to a less expensive care setting. Often, home care is just as important as the inpatient care they received. It’s also valuable for more than just your patient’s health—it can significantly help the financial health of your institution.
There’s a lot of opportunity to reach out to your patient post-discharge and affect the care we provide.”
- Christine Cunningham, RRT
Director of Clinical Services, CHI Health at Home
For example, evidence-based home care programs like the Transitional Care Model target older adults with complex needs. This model prepares patients and caregivers to manage COPD in the home setting. Home care programs like this have been shown to have6:
Tips for boosting your patient’s success at home
Start the shift of care today
Making a patient’s transition from hospital to home seamless isn’t always easy. It takes hard work and dedication from all team members across all care settings. The good new is it can be done. If you involve RTs from the start, develop a strong discharge plan, and invest in maximizing your home care efforts, this shift in care settings may be smoother than you initially thought. And, if you master this process, both your patients and your institution will reap the benefits.
Further reading
References
1. Cost-effectiveness of homecare. American Association of Homecare Web site. https://www.aahomecare.org/issues/cost-effectiveness-of-homecare. Accessed June 29, 2017.
2. Stephenson J. Improve discharge planning for COPD patients, says report. Nursing Times Web site. https://www.nursingtimes.net/news/reviews-and-reports/improve-discharge-planning-for-copd-patients-says-report/7015304.article. Published February 1, 2017. Accessed June 29, 2017.
3. Tips for a successful COPD discharge. Do More With Oxygen Web site. http://www.domorewithoxygen.com/bid/221374/Tips-for-a-Successful-COPD-Discharge. Published September 21, 2012. Accessed June 29, 2017.
4. Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease: 2017 Report. http://goldcopd.org. Accessed June 29, 2017.
5. Aimonino Ricauda N, Tibaldi V, Leff B, et al. Substitutive “hospital at home” versus inpatinet care for elderly patients with exacerbations of chronic obstructive pulmonary disease: a prospective randomized, controlled trial. J Am Geriatr Soc. 2008;56(3):493-500.
6. Krishnan JA, Gussin HA, Prieto-Centurion V, Sullivan JL, Zaidi F, Thomashow BM. National COPD readmissions summit 2013: integrating COPD into patient-centered hospital readmissions reduction programs. Chron Obstruct Pulm Dis. 2015;2(1):70-80.
7. Bourbeau J, Bartlett S. Patient adherence in COPD. Thorax. 2008; 63(9):831-838.
8. Ray SM, Barger Stevens AR. Choosing the right inhaled medication device for COPD. Am Fam Physician. 2013; 88(10):651-652.
9. Lan CC, Chu WH, Yang MC, Lee CH, Wu YK, Wu CP. Benefits of pulmonary rehabilitation in patients with COPD and normal exercise capacity. Respir Care. 2013; 58(9):1482-1488.
