Why every COPD patient needs a case manager
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Managing the best interests of the patient as a whole
All medical professionals have the best interests of their patients at heart, but with so many moving parts and so many different individuals involved in patient care, it’s easy for things to fall through the cracks. Having a case manager is critical to addressing that problem. By ensuring continuity across care settings, case managers give patients the care they deserve at every step of the process. You can have a world-class care team, but without the connective tissue a case manager provides, you multiply the risk that a gap in care will lead to a readmission. It’s an invaluable investment that supports better outcomes for all.
The MVPs of your care team, no matter what you call them
According to the Case Management Society of America, “case management is a collaborative process of assessment, planning, facilitation, care coordination, evaluation and advocacy for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote patient safety, quality of care and cost-effective outcomes.”1 Case managers go by a variety of names and titles, depending on the institutions they work for. “We've heard COPD coordinator, we've heard COPD educator, we've heard COPD disease manager, and more recently, COPD case manager,” says Vernon Pertelle. No matter what you call them, case managers have one thing in common: They’ve been credentialed through an official certifying body like the American Case Management Association, the Commission for Case Manager Certification or the American Nurses Credentialing Center. Regardless of their backgrounds—whether they’re a registered nurse, a respiratory therapist, a social worker, or something else entirely—or their official titles, a certified case manager is often the missing piece in maximizing COPD outcomes.2
Contributors
Roberto Benzo, MD, MSc
Motivational Based Health Coaching
Krystal Craddock, BSRC, RRT-NPS, AEC
COPD Case Manager Department of Respiratory Care at UC Davis Medical Center
Keith T. Kanel, MD, MHCM, FACP
Clinical Associate Professor of Medicine University of Pittsburgh
Vernon Pertelle, RRT
President and CEO StratiHealth Management Consultant for ACOs
We've heard COPD coordinator, we've heard COPD educator, we've heard COPD disease manager, and more recently, COPD case manager”
Vernon Pertelle, RRT
President and CEO StratiHealth Management Consultant for ACOs
Let’s take a deeper look at a case manager’s distinctive value—and why every patient should have one.
A case manager provides frontline education and engagement
For patients, dealing with COPD can feel scary and overwhelming. In fact, studies have found that over 40% of COPD patients struggle with depression.3 Establishing a personal relationship with a patient and showing a little bit of empathy can go a long way.
People feel reassured that somebody cares.”
Roberto Benzo, MD, MSc
Motivational-Based Health Coach
By educating patients and getting to know them, case managers can help patients stay informed, cope with their situation and drive change in a patient’s lifestyle at home to help them avoid exacerbations. “I believe that if you just focus on the patient and provide them with the best education, and sit down and provide empathy, if you do all of that, and you really commit to doing it and you do it with passion, that the numbers follow,” says Krystal Craddock, a COPD case manager. “The readmission rates will come down if we all just come together to treat the patient.”
You need someone who is really driven to want to help the patient manage their disease at home and to help improve quality of life. Not just saving a life at that moment. You're really thinking about what's going to happen to the patient after they leave the hospital. You need someone who's caring, who wants to take their time at the bedside with the patient. Talk about their home life, their social issues, their family support, and recommend patients for outpatient pulmonary rehab, different support groups for that patient to help not only treat their disease with medications but also get them out of the house. Get them breathing better, get them exercising, and really that social aspect helps with their spirits and helps them feel better as well.
Krystal Craddock, BSRC, RRT-NPS, AE-C, CCM
COPD Case Manager UCal Davis
“Patient engagement is critical,” says Roberto Benzo, a motivational-based health coach. “It's a missing piece sometimes in the decision making. We need, of course, a proper treatment, we need a proper professional, but we need the patient, because at the end of the day, all changes happen in the patient’s home.” If a patient isn’t properly educated or isn’t in the right state of mind to make wise lifestyle choices, you run a high risk of seeing them back in the hospital sooner rather than later.
Insider insight: The prevalence of COPD readmissions4
According to an analysis of the Nationwide Readmissions Database:
19%
of COPD exacerbation patients are readmitted within 30 days
4.2% - 5.5%
are readmitted within 72 hours of discharge
58%
of readmissions occur in the first 15 days
A case manager has the knowledge needed to personalize care
After truly getting to know a patient and the details of their condition, who better to oversee their care journey than the case manager?
A case manager becomes an expert on the specifics of each patient’s situation, and as a result, they’re best suited to coordinate care and advocate for that patient from start to finish. Many COPD patients are dealing with other medical issues in addition to COPD. In fact, studies have found that nearly 70% of COPD patients suffer from comorbidities that require multiple types of treatment.5 Case managers can serve as a liaison among different members of the care team to coordinate those varying treatments—ensuring that everything is properly addressed and that treatments or medications don’t conflict or negatively interact. Without the presence of a case manager, there’s a greater risk of fragmented, ineffective care. “We're not just focusing on their COPD, we're looking to see if they also have heart failure, we're having a pharmacist coming to the bedside and going over all their medications. The case manager will teach the patient about their disease and how to use their inhalers and get them on the right things,” Craddock says. “Bringing all of these once-siloed disciplines together to help manage the patient as a whole is really what improves outcomes.”
Every patient can benefit from a case manager, but who makes for the best case managers?
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In addition to keeping all members of the COPD care team on the same page and making sure a patient’s chart is accurate and complete, a case manager also helps with things like insurance issues and making sure the patient knows how to properly take their medication or adhere to treatment like pulmonary rehab. The various members of a care team play a role in these things as well, but a case manager is the glue that holds everything together.
A case manager facilitates the transition home and follows up to make sure patients stay on track
COPD patients deal with many members of a care team during a hospital stay, and they are expected to process and retain an abundance of information. As a result, COPD patients can feel a little lost or overwhelmed after discharge.
“The single most vulnerable part of a COPD patient's transition out of the hospital is the microsecond after discharge.”
Keith T. Kanel, MD, MHCM, FACP
Clinical Associate Professor of Medicine University of Pittsburgh
Keeping COPD patients healthy at home can be a fine line to walk. You don’t want your patients making an unnecessary trip to the hospital or emergency room because they feel like they can’t manage on their own—but you also don’t want to push them to stay home when they could actually be in legitimate need of inpatient medical treatment. Having a case manager to check in on patients after discharge, and offer advice on dealing with COPD at home, can prevent avoidable hospitalizations.
Before, when a patient would come in with COPD, we would kind of say, ‘Follow up with your primary care doctor.’ We can't really do that anymore.”
Krystal Craddock, BSRC, RRT-NPS, AE-C, CCM
COPD Case Manager UCal Davis
“When they leave the hospital and walk into the sunshine after being in a bed for five days, they have in their left hand a handful of paper prescriptions for medicines that they might or might not get, they might or might not be able to afford, they might have been trained on how to use them or not,” says Keith Kanel, MD, MHCM, FACP, Clinical Associate Professor of Medicine at the University of Pittsburgh. That’s where a case manager can make a difference, by dealing with follow-up tasks that were often neglected in the past. From checking in on patients to make sure they’re adhering to treatment and attending appointments, to ensuring patients have a safe and healthy environment to recuperate in, a case manager is the proactive failsafe that can reduce COPD readmissions.6,7 “Now, when a patient with COPD is admitted into the hospital, they're followed by a COPD case manager,” explains Craddock. “Not only to treat them acutely, but in the continuum to make sure that they go home, they transition home safely, and they manage their disease at home.”
Insider insight: The impact of a case manager on COPD patients7
A retrospective outcome study across five large hospitals in Vancouver after the implementation of a comprehensive case management program found a:
30%
reduction in COPD-related hospitalizations
14%
reduction in all-cause hospitalizations of COPD patients
37%
decrease in length of stay
Start your own COPD case manager program
Start your own COPD case manager program
Investing in a case manager initiative at your institution might seem like a monumental task, but it’s an undertaking that will undoubtedly pay off in the long run. The key, according to Craddock, is to start small. “We started with seeing patients who were in for COPD who could really be involved in the bedside education,” Craddock says. “So our severe psychiatric patients, our patients going through drug withdrawals, we weren't seeing at first, because we really wanted to figure out the program before we expanded it to everyone. After figuring out what worked and what didn't work and what we needed to change, then we started seeing all patients with COPD and treating them equally, and we've shown great outcomes with it.” This level of focused care will help make a dramatic difference for patients and your institution.
Insider case study: Implementing a case manager program University of California Davis Medical Center
The problem:
High burden of COPD care
The plan:
UCal Davis received a $160,000 grant to implement a case manager program in an attempt to reduce COPD readmissions. Eight UCal Davis respiratory therapists began training for case manager certification. Their training included weekly two-hour classes with their medical director and pulmonologist as well as a COPD educator course through the American Association of Respiratory Care. The respiratory therapists learned about things like motivational interviewing, health literacy, and GOLD guidelines.
The solution:
After the case managers were certified, they began seeing patients who were admitted for COPD exacerbation to provide education and support. “We met with them every day and we talked to them about what their disease was, how to treat it, the different medications that were out there,” said Krystal Craddock, one of the eight therapists who participated in the program. “We really assessed the patient to find out what they tried in the past and what didn't work for them and why.”
The outcome:
Significant decrease in the burden of COPD care
The grant money ran out after three years, but the COPD case manager program continues due to its success.
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Further reading
COPD insider
References 1. What is a case manager? Case Management Society of America. http://www.cmsa.org/who-we-are/what-is-a-case-manager. Accessed March 18, 2019. 2. Case managers: keys to maximizing COPD health outcomes. COPD Foundation. https://www.copdfoundation.org/Praxis/Community/Blog/Article/532/Case-Managers-Keys-to-Maximizing-COPD-Health-Outcomes.aspx. Accessed March 18, 2019. 3. Stage KB, Middelboe T, Stage TB, Sørensen CH. Depression in COPD—management and quality of life considerations. Int J Chron Obstruct Pulm Dis. 2006;1(3):315-320. 4. Jacobs DM, Noyes K, Zhao J, et al. Early hospital readmissions after an acute exacerbation of chronic obstructive pulmonary disease in the Nationwide Readmissions Database. Ann Am Thorac Soc. 2018;15(7):837-845. 5. Anecchino C, Rossi E, Fanizza C, De Rosa M, Tognoni G, Romero M. Prevalence of chronic obstructive pulmonary disease and pattern of comorbidities in a general population. Int J Chron Pulmon Obstr Dis. 2007;2(4):567-574. 6. van Eeden AE, van de Poll I, van Vulpen G, et al. Effectiveness of case management in the prevention of COPD re-admissions: a pilot study. BMC Res Notes. 2017;10:621. 7. Alshabanat A, Otterstatter MC, Sin DD, et al.; on behalf of the COPD Transition Team Program. Impact of a COPD comprehensive case management program on hospital length of stay and readmission rates. Int J Chron Pulmon Obstr Dis. 2017;12:961-971.
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