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

Bhatt, Surya P.; Patel, Siddharth; Anderson, Erica; Baugh, D.; Givens, Tina; Schumann, Christopher; Sanders, J.; Windham, Samuel T.; Cutter, Gary; Dransfield, Mark T.

doi:10.1164/rccm.201902-0314le

Cited by 52 publications

(44 citation statements)

References 13 publications

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“…24 The time to complete the CAT is significantly shorter than that for the SGRQ and it requires less assistance; 25 it has been used in telehealth cohorts to monitor exacerbation risk or the impact of pulmonary rehabilitation. 26,27 The use of the CAT-based definition would thus be of particular benefit in real-world trials where CMH is a trait to be identified. Further work and validation in other cohorts will be necessary to understand whether subtle differences exist between the two, with potential impact on patient selection or risk assessment.…”

Section: Discussionmentioning

confidence: 99%

<p>Defining Chronic Mucus Hypersecretion Using the CAT in the SPIROMICS Cohort</p>

Stott-Miller¹,

Müllerová²,

Miller³

et al. 2020

COPD

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Background: Chronic cough and phlegm are frequently reported chronic obstructive pulmonary disease (COPD) symptoms. Prior research classified chronic mucus hypersecretion (CMH) based on the presence of these symptoms for ≥3 months, called chronic bronchitis (CB) if respiratory infection symptoms were present for 1-2 years (Medical Research Council [MRC] definition). We explored whether the COPD Assessment Test (CAT), a simple measure developed for routine clinical use, captures CMH populations and outcomes similarly to MRC and St. George's Respiratory Questionnaire (SGRQ) definitions. Methods: We identified CMH in the SPIROMICS COPD cohort using (a) MRC definitions, (b) SGRQ questions for cough and phlegm (both as most/several days a week), and (c) CAT cough and phlegm questions. We determined optimal cut-points for CAT items and described exacerbation frequencies for different CMH definitions. Moderate exacerbations required a new prescription for antibiotics/oral corticosteroids or emergency department visit; severe exacerbations required hospitalization. Results were stratified by smoking status. Results: In a population of 1431 participants (57% male; mean FEV 1 % predicted 61%), 47% and 49% of evaluable participants had SGRQ-or CAT-defined CMH, respectively. A cut-point of ≥2 for cough and phlegm items defined CMH in CAT. Among SGRQ-CMH+ participants, 80% were also defined as CMH+ by the CAT. CMH+ participants were more likely to be current smokers. A higher exacerbation frequency was observed for presence of CMH+ versus CMH− in the year prior to baseline for all CMH definitions; this trend continued across 3 years of follow-up, regardless of smoking status. Conclusion: Items from the CAT identified SGRQ-defined CMH, a frequent COPD trait that correlated with exacerbation frequency. The CAT is a short, simple questionnaire and a potentially valuable tool for telemedicine or real-world trials. CAT-based CMH is a novel approach for identifying clinically important characteristics in COPD that can be ascertained in these settings.

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Section: Discussionmentioning

confidence: 99%

<p>Defining Chronic Mucus Hypersecretion Using the CAT in the SPIROMICS Cohort</p>

Stott-Miller¹,

Müllerová²,

Miller³

et al. 2020

COPD

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“…Our results reveal a 40% reduction in the readmission rate by proactively targeting preventive intervention toward high-risk hospitalizations of home care patients. Previous studies also showed that a great portion of 30-day readmissions are avoidable through a series of resource-intensive interventions, including post-acute support, post-discharge monitoring [24], telehealth rehabilitation programs [25], and home care case management [26,27]. A readmission prediction model is of course the very first step to stratify patients and optimize resource utilization for home care patients.…”

Section: Discussionmentioning

confidence: 99%

Assess the Performance and Cost-Effectiveness of LACE and HOSPITAL Re-Admission Prediction Models as a Risk Management Tool for Home Care Patients: An Evaluation Study of a Medical Center Affiliated Home Care Unit in Taiwan

Wang

Chen

et al. 2020

IJERPH

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The LACE index and HOSPITAL score models are the two most commonly used prediction models identifying patients at high risk of readmission with limited information for home care patients. This study compares the effectiveness of these two models in predicting 30-day readmission following acute hospitalization of such patients in Taiwan. A cohort of 57 home care patients were enrolled and followed-up for one year. We compared calibration, discrimination (area under the receiver operating curve, AUC), and net reclassification improvement (NRI) to identify patients at risk of 30-day readmission for both models. Moreover, the cost-effectiveness of the models was evaluated using microsimulation analysis. A total of 22 readmissions occurred after 87 acute hospitalizations during the study period (readmission rate = 25.2%). While the LACE score had poor discrimination (AUC = 0.598, 95% confidence interval (CI) = 0.488-0.702), the HOSPITAL score achieved helpful discrimination (AUC = 0.691, 95% CI = 0.582-0.785). Moreover, the HOSPITAL score had improved the risk prediction in 38.3% of the patients, compared with the LACE index (NRI = 0.383, 95% CI = 0.068-0.697, p = 0.017). Both prediction models effectively reduced readmission rates compared to an attending physician's model (readmission rate reduction: LACE, 39.2%; HOSPITAL, 43.4%; physician, 10.1%; p < 0.001). The HOSPITAL score provides a better prediction of readmission and has potential as a risk management tool for home care patients.

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“…Wenn in den USA Patienten mit COPD-Exazerbation innerhalb von 30 Tagen nach Entlassung wieder stationär aufgenommen werden, muss die Klinik hohe Geldzahlungen leisten. In einer aktuellen Publikation wurde gezeigt, dass Telemedizin die Wiederaufnahmeraten reduzieren kann [67]…”

Section: Telemedizinisch üBerwachte Häusliche Rehabilitationunclassified

Expertentreffen COPD: Technologische Innovationen in der Pneumologie – Facetten aus Diagnostik und Therapie

et al. 2020

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ZusammenfassungEin wesentlicher Anteil der aktuellen technologischen Entwicklungen in der Pneumologie liegt in den verschiedenen Bereichen der Informationstechnologie. Das Spektrum reicht dabei von Smartphone-Apps, die im täglichen Leben oder der Praxis von Patienten oder Ärzten angewandt werden sollen, bis hin zum Einsatz der künstlichen Intelligenz in der Früherkennung. Die Diagnose-Genauigkeit von Apps zur Symptomanalyse ist dabei zurzeit noch sehr limitiert. Forschungsprojekte beschäftigen sich mit der Integration von Symptomen und Funktionsparametern in der Früherkennung, aber auch mit der Mobilitätserfassung als prognostischem Marker bei der COPD. Eine große Herausforderung stellt das Lungenkrebs-Screening mittels Computertomografie dar. Hier kann künstliche Intelligenz helfen, riesige Datenmengen zu bewältigen. Die Qualität hängt jedoch vom suffizienten Training der Systeme ab. Technologische Entwicklungen prägen alle Felder der Pneumologie. Sie erlauben in der diagnostischen und interventionellen Endoskopie die verbesserte Biopsietechnik und mikrostrukturelle Bildgebung. Methoden der Lungenfunktionsdiagnostik ermöglichen die differenzierte Analyse von atemmechanischen Störungen und können in die Beatmungstechnologie überführt werden. Die Translation von Grundlagenerkenntnissen zum Mikrobiom kann perspektivisch helfen, COPD-Exazerbationen besser zu verstehen und zielgerichteter zu behandeln.

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

Cited by 52 publications

References 13 publications

<p>Defining Chronic Mucus Hypersecretion Using the CAT in the SPIROMICS Cohort</p>

<p>Defining Chronic Mucus Hypersecretion Using the CAT in the SPIROMICS Cohort</p>

Assess the Performance and Cost-Effectiveness of LACE and HOSPITAL Re-Admission Prediction Models as a Risk Management Tool for Home Care Patients: An Evaluation Study of a Medical Center Affiliated Home Care Unit in Taiwan

Expertentreffen COPD: Technologische Innovationen in der Pneumologie – Facetten aus Diagnostik und Therapie

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