Below is additional proof that the future of respiratory therapy is in disease management:
Patty C Silver, Marin H Kollef, Darnetta Clinkscale, Peggy Watts, Robin Kidder, Brittany Eads, DebbieBennett, Carolyn Lora, Michael QuartaroRespiratory Care Jan 2017, 62 (1) 1-9; DOI: 10.4187/respcare.05030
BACKGROUND: Patients with COPD often require repeated emergency department visits and hospitalizations for COPD exacerbations. Such readmissions increase health-care costs and expose COPD patients to the added risks of nosocomial infections and increased mortality.
METHODS: To determine whether a respiratory therapist (RT) disease management program could reduce re-hospitalization and emergency department visits, a prospective, single-center, unblinded, randomized trial was performed.
RESULTS: We enrolled 428 subjects (214 intervention, 214 control). The primary outcome (combined non-hospitalized emergency department visits and hospital readmissions for a COPD exacerbation during the 6-month follow-up) was similar for the study groups (91 vs 159, P = .08). When the 2 components of the primary end point were analyzed individually, the percentage of subjects with non-hospitalized emergency department visits for COPD exacerbations was similar between groups (15.0% vs 15.9%, P = .79). Readmission for a COPD exacerbation was significantly lower in the intervention group (20.1% vs 28.5%, P = .042). The median (interquartile range) duration of hospitalization for a COPD exacerbation was less for the intervention group (5 [3–11] d vs 8 [4–18.5] d, P = .045). In-patient hospital days (306 d vs 523 d, P = .02) and ICU days (17 d vs 53 d, P = .02) due to COPD exacerbations were significantly less for the intervention group. Mortality was similar for both groups (1.4% vs 0.9%, P > .99).
CONCLUSIONS: Our RT disease management program was associated with less readmission, fewer ICU days, and shorter hospital stays due to COPD exacerbations. Further studies are needed to determine the optimal utilization of RT disease management teams for patients with COPD to optimize outcomes and prevent return hospital visits. (ClinicalTrials.gov registration NCT01543217.)
It only makes sense that employing clinicians with specialized training in respiratory disease management to improve the outcomes of patients with lung disease is the best route to take in achieving this goal. This study should be in the back pocket of those in positions of influence within the respiratory care world. Because decision makers are busy people who are constantly being bombarded with a myriad of fires to put out, we as respiratory care professionals need to be able to quickly back the value of our abilities with convincing data.
Respiratory therapists (RT) will be most valuable over the next decade utilizing their assessment and care planning skills in areas where we have not historically existed in significance. Areas like skilled nursing and case management are just two such areas. It will be hard to break into skilled nursing, however, until the reimbursement structure for this environment pays the owners of these companies for providing respiratory care only by those who hold a respiratory therapy credential. This won’t happen until we RTs utilize data such as this en masse in our lobbying efforts.
In the short run, just be vocal about the value you bring to the clinical team, and be able to back it up with evidenced-based data. The more of us who offer smart solutions to difficult challenges, the more we will be sought after to solve such dilemmas.