Respiratory Disease Management

• Hospitalizations and ED visits for other causes [ Time Frame: up to 3 months ] [ Designated as safety issue: No ]
  Number of times a subject is hospitalized or visit the ED during the study period.
• Hospital and intensive care unit (ICU) lengths of stay [ Time Frame: 6 months ] [ Designated as safety issue: No ]
  the number of days a subject is in the intensive care unit
• Respiratory medication use [ Time Frame: 6 months ] [ Designated as safety issue: No ]
  prescribed respiratory medications dose and usage
• All causes of mortality [ Time Frame: 6 months ] [ Designated as safety issue: No ]
  documentation of all causes of mortality

The aim of this study is to reduce the number of subsequent hospital admissions and/or emergency department (ED) visits for hospitalized patients with chronic obstructive pulmonary disease (COPD) by utilizing a respiratory care practitioner-led disease management (RCP-DM) program compared to standard discharge instructions and planning.

The investigators propose to carry out a prospective, randomized, trial at Barnes-Jewish Hospital (1250-bed urban academic hospital). Eligible patients will be identified by a senior study coordinator who will also obtain informed consent for study participation. Adults greater than 18 years of age and less than 65 years of age will be eligible for enrollment if the lead investigator and the treating physician agree that the patient meets the enrollment criteria which include the following: patients with spirometrically confirmed COPD at high risk for repeat hospitalization or ED visits as predicted by hospital admission or ED visit in the previous 12 months for a COPD exacerbation, chronic home use of oxygen, or a course of systemic corticosteroid therapy in the preceding 12 months. Exclusion criteria include patients not expected to survive their hospitalization, presence of metastatic cancer, bed-bound individuals, non-English speaking patients, and patients unable to provide informed consent.

• Other: RT management
  Patients assigned to the RT management arm will receive a 1-hour educational in-service conducted by a respiratory therapist case manager. The patient education session will include general information about COPD, direct observation of inhaler techniques, a review and adjustment of outpatient COPD medications, smoking cessation counseling, recommendations concerning influenza and pneumococcal vaccinations, encouragement of regular exercise, and instruction in hand hygiene.
• Other: Ususal care
  Routine respiratory care.

• Active Comparator: Control
  Ususal care.
  Intervention: Other: Ususal care
• Active Comparator: Intervention
  Patients assigned to the RT management arm will receive a 1-hour educational in-service conducted by a respiratory therapist case manager. The patient education session will include general information about COPD, direct observation of inhaler techniques, a review and adjustment of outpatient COPD medications, smoking cessation counseling, recommendations concerning influenza and pneumococcal vaccinations, encouragement of regular exercise, and instruction in hand hygiene.
  Intervention: Other: RT management

Inclusion Criteria:

• Adults greater than 18 years of age and less than 64 years of age will be eligible for enrollment if the lead investigator and the treating physician agree that the patient meets the enrollment criteria which include the following:

  • patients with spirometrically confirmed COPD at high risk for repeat hospitalization or emergency department (ED) visits as predicted by hospital admission or ED visit in the previous 12 months for a COPD exacerbation,
  • chronic home use of oxygen, or
  • a course of systemic corticosteroid therapy in the preceding 12 months.

Exclusion Criteria:

• patients not expected to survive their hospitalization,
• presence of metastatic cancer,
• bed-bound individuals,
• non-English speaking patients, and
• patients unable to provide informed consent.