respiratory care practitioners

© Aurora Health Care, Inc.© Aurora Health Care, Inc.

By Laura Kranitz RRT CPFT

Respiratory Care Practitioners As A Health Care Resource

A Vision for the Future Careof Our COPD Patients.

An Investigation of the Opportunity for Utilizing Respiratory Therapists in the Hospital and Clinic Settings to Aid the Discharge Process of Our COPD Patients Leading to Improved Post Care Management, Decreased Hospital Admissions and Reduced Health Care Costs

© Aurora Health Care, Inc.

General Background

• According to the COPD Foundation– Chronic Obstructive Pulmonary Disease

(COPD)– Is an umbrella term used to describe

progressive lung diseases including emphysema, chronic bronchitis, refractory (non-reversible) asthma and some forms of bronchiectiasis

– In 2015 CMS to reduce IPPS reimbursements to hospitals with excessive COPD readmissions


COPD Statistics

According to the CDC:• 70% of the 24M US COPD patients are

under the age of 65.– Of those ½ are undiagnosed

• % of WI Adult Population with COPD– Age Groups:

• 45-54 = 6.2%• 55-64 = 7.1%• 65-74 = 11.4%• > 75 = 9.1%


Data from the COPD Foundation COPD Readmissions Summit October 11, 2013• Over 800,000 hospital admissions per year

are from COPD • About 20% of hospitalized patients with COPD

are readmitted within 30 days.• Another 3.8 M stays included COPD as a

secondary or complicating condition.

»1 in 5 hospitalized individuals over age 40 has a diagnosis of COPD


COPD Foundation Physician Survey• 61.1% of PCPs consider

their COPD education exposure inadequate

• 64.4% of PCPs value clinical practice guidelines to help guide clinical practice.

• 44.9% of PCPs are unaware of the current COPD clinical practice guidelines.


The Global Initiative for Chronic Obstructive Lung Disease (GOLD)

• Developed in 1998 with the WHO, NIH and National Heart, Lung and Blood Institute.

• Evidence based clinical practice guidelines updated for 2014.

• Provides standardized treatment and medication recommendations based on the latest scientific studies.


The Global Initiative for Chronic Obstructive Lung Disease (GOLD)• Classifies COPD patients into four groups

based on– Symptoms– Degree of airflow limitation (using spirometry)– Risk of exacerbation– Comorbidities

• GOLD requires a spirometry in the presence of a post bronchodilator to provide a clinic diagnosis of COPD.

• “All health care workers who care for COPD patients should have access to spirometry”


How Can Respiratory Therapists Help Reduce Hospital Readmissions?• They are uniquely trained to assist physicians

in both the inpatient and outpatient settings.• In the hospital RTs can:

– Assess patients per protocol to GOLD classifications including spirometry.

– Become valuable members of a multidisciplinary discharge planning team as soon as patient is admitted. (MD,RN,RT, SW, CM, PT/OT)

– Educating patients and caregivers on the disease, use of medications and various DME devices prior to discharge.


How Can Respiratory Therapists Help Reduce Hospital Readmissions?• In the clinic RTs can:

– Assist PCPs by classifying the severity of patient’s COPD per GOLD using spirometry.

– Perform hospital follow up visits that include:• Patient and caregiver education on the disease process

and use of various inhalers and medications.• Develop with the patient their personal COPD Action plan• How to avoid risks by reviewing smoking cessation and

vaccinations and oxygen therapy• Referrals for out patient pulmonary rehab.• Document, monitor and improve outcomes• Develop a care team between the PCP,RN,

patient, family and RT.


Use Trained, Experienced Respiratory Care Practioners (RCP) – Clinical Specialists• NBRC Registered Respiratory Therapist

(RRT)• AARC COPD Certified Educator• NAECB Asthma Educator (AE-C)• Health Science Related Bachelor DegreeHR 2619 Medicare Respiratory Therapist

Access Act of 2013 It will amend Medicare Part B to provide

coverage of pulmonary self-management education and training by a qualified RCP in the physician practice setting.


UC Davis Health System Using RCPs as COPD Case Managers –Results of Two Year StudyReceived a grant from the University of California


How Can Hospitals Reduce Readmissions?American Hospital Association (AHA) Recommendations

• Focus on avoidable hospitalizations• Enhance discharge planning• Partner with post-acute care providers

– Aurora Medical Center Grafton– Aurora Advanced Healthcare

• Use health care personnel with advanced training to provide disease specific patient education.

• Develop a high-risk patient readmission tool using the evidence based GOLD 2014 guidelines.

• Appoint a discharge advocate to schedule PCP follow up visits and follow up telephone calls.

• Develop personalized COPD Action plans, teach self-management and make referrals to pulmonary rehab.


References• Global Initiative for Chronic Obstructive Lung Disease, 2013 (WHO, NIH

and National Heart, Lung and Blood Institute)• COPD Management, Avoiding Readmissions Due to Acute

Exacerbations, RT Magazine, October 2013 (part 1), November, 2013 (part 2) by Timothy Op’t Holt, EDD, RRT, AE-C FAARC

• Reducing COPD Readmissions, Webinar 4/28/2014 RT Magazine– Deb McGowan COPD Foundation (Carolinas Healthcare System (CHS)– Samuel Louie, MD

• Director, UC Davis Health System ROAD program, (Reversible Obstructive Airway Diseases)

• Director, UC Davis Pulmonary Rehabilittation Program and UC Davis Asthma Network (UCAN)

– Krystal Craddock, RCP, RRT-NPS• COPD Case Manager, Department of Respiratory Care, UC Davis Medical Center

– Bill Pruitt, MBA, RRT, AE-C, CPFT• Senior Instructor and Director of Clinical Education, Department of

Cardiorespiratory Care, University of South Alabama (Mobile)• Staff therapist for the COPD and Asthma Clinic at Victory Health Partners Clinic

(Mobile)

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