Reducing 30-day hospital readmissions for chronic obstructive pulmonary disease in southwest Montana: a quality improvement project

Abstract

Chronic obstructive pulmonary disease (COPD) recently joined the leading causes of hospital readmission. Readmissions range from 7% up to 82.2% with the highest rate amongst home-bound patients. Post-discharge programs demonstrate varied impacts on 30-day COPD readmission rates. Home health provides evaluation and treatment management opportunities for the most at-risk population and the literature lacks studies evaluating patient outcomes with a home health nurse-driven COPD protocol. At the project site, the hospital COPD 30-day readmission rate for patients > or = 65 years averaged 28.8% from 2018 to 2021. The clinic stakeholders recorded two 30-day readmissions during calendar year 2023. To reduce 30-day COPD hospital readmissions and identify home health qualifying patients a COPD Home Health Protocol and participant qualifying identification tool were created and evaluated with descriptive statistics. Two interventions were initiated: a provider approved, nurse-driven home health protocol managing COPD symptoms; an electronic health record .dotphrase identifying home-bound patients qualified for home health and the COPD nurse-driven protocol. The project aims were partially achieved with a 75% utilization rate of the home health qualifying .dotphrase and successful identification of one possible home health candidate who refused home health services. No patients received the COPD home health protocol during the eight-week study period. The project successfully identified participants qualifying for home health but lacked sufficient opportunity to evaluate the COPD home health protocol. Expanding age inclusion criteria to participants > or = 50 years will more effectively evaluate the at-risk population.