NSG2NCI | Nursing Patients | Reducing The Rate Of Re-hospitalization

In COPD patients discharged to home, how home health care involvement to no home care involvement affects patient outcomes regarding re-admissions to the hospital within 3-6 months after discharge.

Chronic Obstructive Pulmonary Disease is a universal term that is usually used to describe an array of diseases that affect the lungs. The underlining characteristic of the disease is increased breathlessness. It is very unfortunate that the disease is progressive and has no cure. With the correct diagnosis and treatment, however, the condition can be managed well to improve breathing (Apps, et al, 2016). In Emphysema, for example, the alveoli are damaged and inelastic making it difficult for air to move in and out. In chronic bronchitis, the bronchial airways get inflamed and destruction of cilia which sweep mucus and make the airways clean (Apps et al., 2016). Mucus, in turn, build up and cause difficulties in breathing. In Asthma, the airways tighten and swell.

Therefore the clinical question of interest is, In COPD patients discharged to home, how home health care involvement transition to no home care involvement affects patient outcomes regarding re-admissions to the hospital within 3-6 months after discharge.

Purpose of the change proposal

This project will focus on highlighting the aspects that concern reducing the rates of re-hospitalization in home healthcare patients.

PICOT

Population

The population that is at risk of Chronic Obstructive Pulmonary Disease primarily are the smoking population. However, the population that gets exposed to other irritants like chemicals are also likely to suffer from the condition. This may include those people who work in industries that deal with pesticides, fungicides and herbicides. Farmers are also at risk when spraying those chemicals in their farms. This is to simply mean that any population that is exposed to substances that can irritate the airways is at risk of the Chronic Obstructive Pulmonary Disease.

Intervention

Currently, there is no standard method for treating Chronic Obstructive Pulmonary Disease. The only intervention programs available are managed to improve on the symptoms and prevent exacerbations of the condition. Changes or effect of the Chronic Obstructive Pulmonary Disease is irreversible as long as the patient continues smoking. This is because the condition causes a merging of alveoli to form inelastic sacs which subsequently reduce the surface area of the alveolar membrane leading to impaired gaseous exchange (Pascoe et al., 2015).

The best interventions that can be utilized are palliative care and oxygen therapy (Lange et al., 2015). Palliative care is a form of service offered to individuals with life-threatening conditions and Chronic Obstructive Pulmonary Disease is among them. Chronic Obstructive Pulmonary Disease is regarded as one of the terminal illnesses that only need palliative care.  The Chronic Obstructive Pulmonary disease results in the destruction of the alveoli in the lungs rendering them ineffective when it comes to the ability to oxygenate the blood. This, therefore, necessitates the supply of oxygen which is achieved through oxygen therapy

Expected Outcomes

Since the effect or rather the damage that arises from the COPD is irreversible, the only expected outcome is to prolong life devoid of frequent hospitalizations.

Time Frame

In the case of palliative care, there is no expected time of recovery rather the time it takes for the patient to die. The intervention in this particular case, therefore, does not have any definite time frame. However, the care has to be provided up to that time the patient will die.

Literature search strategy employed

The study employed a critical analysis of relevant extant literature by first designing research questions aimed at providing answers to the study topic. Databases such as Pubmed, Google Scholar and Science Direct were used including keywords readmissions, heart failure, home monitoring and follow-ups to draw relevant articles for analysis.

Evaluation of the literature

Adib-Hajbaghery, Maghaminejad & Abbasi, (2013) aimed at investigating the reduction in readmission rates through continuous care post heart failure using qualitative study design (random sampling) and found out that patient education along with follow-ups significantly improved the quality of care. This finding is supported by another study conducted by Brewster et al., (2016) where they highlighted the fact that patient education and effective follow-up after discharge has reduced hospital re-admissions ensuring continuity of care by improving medical performance. This finding is not consistent with another study conducted by Delbridge et al., (2016) as it was aimed at studying BCL-2 protein family and its role in cancer therapy and development.

However, another study conducted by Kripalani et al., (2014) supported the capstone project that multiple interventions like patient education; outpatient follow-ups after discharge have successfully reduced readmissions for patients who are discharged to home. Another study conducted by Li et al., (2015) was aimed at exploring the transition care needs before discharge to reduce mortality risk and readmissions after surgery. The authors found out that the most senior patients had the highest transitional care needs (TCN) (49%) with their major TCNs being rehabilitation services. Whereas, Martínez-Jiménez et al., (2017) found out that formerly unknown mutations were possibly responsible for drug resistance.

On a contrary, Morrison, (2016) studied the outcomes of transitional care programs in regards to self-management after discharge from the hospital with a significant reduction in hospital re-admissions. He found out that patients under CNS intervention had substantial lower ED visits and hospitalizations in the sixteen weeks of post-intervention than those under intervention under the same time period. Nelson & Pulley, (2015) also examined the effectiveness of transitional care in avoiding hospital re-admissions as the key factor in quality care and patent safety.

Applicable change

The applicable change towards the treatment of Chronic Obstructive Pulmonary Disease is the use of interventions such as palliative care and oxygen therapy because the illness is irreversible and the initiatives can only manage to improve on the symptoms and prevent exacerbations of the condition.  Palliative care is, however, a big umbrella that includes holistic approach especially for patients in Home Care. Holistic patient serves to give the patient hope that a supernatural power might come to their rescue someday. The Chronic Obstructive Pulmonary disease results in the destruction of the alveoli in the lungs rendering them ineffective when it comes to the ability to oxygenate the blood. This, therefore, necessitates the supply of oxygen which is achieved through oxygen therapy (Lange et al., 2015).

The proposed implementation plan with outcome measures

The preventive efforts to be addressed in this report include introducing patient seminars. The home healthcare providers can also create programs to identify patients who are at high risk of getting re-hospitalized and ensure they are monitored closely (Brook et al., 2013). Successful implementation of these initiatives will require home healthcare providers to make necessary arrangements in terms creating the relevant departments and hiring relevant staff that should be in charge of overseeing the implementation of the initiatives to ensure quality healthcare across all the patients (Ellery et al., 2006).     

The measures for the successful implementation of the proposed initiatives include a reduction in the cases of re-hospitalization for patients. There will also be an improvement in the quality of healthcare. The initiatives can also help in reducing the costs incurred due to re-hospitalization. There will be an improvement in communication relationship between patient and physician to enhance better healthcare by effectively monitoring the patients to administer individualised care (Curtis, Millman, & Struening, 2000).

Identification of potential barriers to plan implementation, and a discussion of how these could be overcome

The potential barriers to the success of the implementation plan will most likely be based on the response of the management of the healthcare providers. The home healthcare providers may be reluctant in providing necessary arrangements such as establishing the required departments that should oversee the implementation of the initiatives. The management can also decline on the installation of appropriate infrastructure on the claims of it being costly. These barriers can be addressed by enlightening the administration of home healthcare providers on the importance of reducing hospitalization in home health care patients through intervention programs as the best and only approach.

References

Adib-Hajbaghery, M., Maghaminejad, F., & Abbasi, A. (2013). The role of continuous care in reducing readmission for patients with heart failure. Journal of caring sciences, 2(4), 255.

Apps, M., Mukherjee, D., Abbas, S., Minter, J., & Whitfield, J. (2016). Integration of hospital and community COPD services including pulmonary rehabilitation can improve patient care and reduce hospital stays.

Brewster, A. L., Cherlin, E. J., Ndumele, C. D., Collins, D., Burgess, J. F., Charns, M. P., ... & Curry, L. A. (2016). What Works in Readmissions Reduction. Medical care, 54(6), 600-607.

Brock, J., Mitchell, J., Irby, K., Stevens, B., Archibald, T., Goroski, A., & Lynn, J. (2013).

Association between quality improvement for care transitions in communities and rehospitalizations among Medicare beneficiaries. Jama, 309(4), 381-391.

Curtis, J. L., Millman, E. J., Struening, E., & D'Ercole, A. (1992). Effect of case management on rehospitalization and utilization of ambulatory care services. Psychiatric Services, 43(9), 895-899.

Delbridge, A. R., Grabow, S., Strasser, A., & Vaux, D. L. (2016). Thirty years of BCL-2: translating cell death discoveries into novel cancer therapies. Nature reviews Cancer, 16(2), 99.

Ellery, S., Pakrashi, T., Paul, V., Sack, S., & Home CARE Phase 0 Study Investigators.(2006). Predicting mortality and rehospitalization in heart failure patients with Home Monitoring—. Clinical Research in Cardiology, 95(3), iii29-iii35.

Gao, C., & Taniguchi, N. (2015). Chronic obstructive pulmonary disease (COPD).

In Glycoscience: Biology and Medicine (pp. 1267-1274). Springer, Tokyo.

Kripalani, S., Theobald, C. N., Anctil, B., & Vasilevskis, E. E. (2014). Reducing hospital readmission rates: current strategies and future directions. Annual review of medicine, 65, 471-485.

Lange, P., Celli, B., Agustí, A., Boje Jensen, G., Divo, M., Faner, R., ... & Meek, P. (2015).

Lung-function trajectories leading to chronic obstructive pulmonary disease. New England Journal of Medicine, 373(2), 111-122.

Li, L. T., Barden, G. M., Balentine, C. J., Orcutt, S. T., Naik, A. D., Artinyan, A., ... &

Anaya, D. A. (2015). Postoperative transitional care needs in the elderly: an outcome of recovery associated with worse long-term survival. Annals of surgery, 261(4), 695-701.

Martínez-Jiménez, F., Overington, J. P., Al-Lazikani, B., & Marti-Renom, M. A. (2017).

Rational design of non-resistant targeted cancer therapies Morrison, J. (2016). Reducing preventable hospitalizations: A study of two models of transitional care.

Nelson, J. M., & Pulley, A. L. (2015). Transitional care can reduce hospital readmissions. Am Nurse Today, 10, 8.

Ng, T. P., Niti, M., Tan, W. C., Cao, Z., Ong, K. C., & Eng, P. (2007). Depressive symptoms and chronic obstructive pulmonary disease: effect on mortality, hospital readmission, symptom burden, functional status, and quality of life. Archives of internal medicine, 167(1), 60-67.

Pascoe, S., Locantore, N., Dransfield, M. T., Barnes, N. C., & Pavord, I. D. (2015). Blood eosinophil counts, exacerbations, and response to the addition of inhaled fluticasone furoate to vilanterol in patients with chronic obstructive pulmonary disease: a secondary analysis of data from two parallel randomised controlled trials. The lancet Respiratory medicine, 3(6), 435-442.