An in-home approach to improving health care
Hospitalizations plummet when patients with COPD get help at home, report finds
It takes David John Langdon exactly 33 steps to get from one end of his apartment to the other.
The 81-year-old Burlington resident knows this because he was diagnosed with chronic obstructive pulmonary disease (COPD) last year, a time when walking from his bedroom to the kitchen counter felt like “choking to death.” Now, Langdon makes the short strides in no time, thanks to a national initiative that saw his care move from the hospital into a nearby community centre close to home. There, respiratory specialists taught Langdon how to manage flare-ups of his disease, all without having to visit an emergency room.
“Now that I have control over the COPD, I never slow down,” he said. “I walk fast. The kids tell me to slow down.” The Canadian Foundation for Healthcare Improvement (CFHI) released a new report Tuesday that shows the number of COPD-related hospitalizations can be cut by up to 80 per cent when health care is provided to patients and their families at home.
The primary cause of the conditions is either smoking or long-term exposure to second-hand smoke. The condition can also stem from air pollution such as industrial dust and chemical fumes. Symptoms range from recurring mucus-filled coughing to wheezing and chest tightness.
According to CFHI, COPD is now the No. 1 reason for hospitalizations in Canada and accounts for the largest number of return visits to emergency departments.
In Ontario, more than 27,000 COPD-related hospitalizations were logged in 2013 to 2014, the most of any province, according to data from the Canadian Institute for Health Information. The average length of hospital stay for these patients was 6.4 days and carries a price tag of roughly $1,000 daily.
“Between the high rate of admissions, readmission and longer lengths of stay, the numbers really add up,” said Stephen Samis, CFHI’s vice-president of programs. Treating people “in their homes, community and out of the hospital,” he explained, can save health-care dollars and lead to more effective treatment.
“We are very proud of our publicly funded health-care system in Canada, but it was designed in the 1950s and1960s, at a time where there were far fewer people living with chronic conditions,” he said. “But the hospital isn’t necessarily the best place to treat conditions like COPD. There is arisk of hospital-acquired infections, along with a whole series of other care issues.”
That’s where a Halifax-created program called INSPIRED, which stands for Implementing a Novel and Supportive Program of Individualized Care for Patients and Families Living with Respiratory Disease, comes into play. The hospital-in-thehome approach is designed to slash the chance of readmission after COPD patients have gone home.
Collaborating with pharmaceutical company Boehringer Ingelheim Canada, CFHI rolled out the INSPIRED initiative at 19 hospitals across Canada from September 2014 to October 2015. Patients with advanced COPD were identified by health care teams and offered the chance to enrol.
Of the 45 patients who participated at Joseph Brant Hospital in Burlington, none was readmitted within 90 days after they returned home.
Melanie Potvin, the hospital’s director of medicine services, said the program “empowered patients to take control of their disease.”
Four phone calls and two in-home visits from nurse educators covered hot topics such as how to use an inhaler, when to take medication, physical exercise, nutrition and tips for managing depression.
According to Potvin, this support system created a “soft landing” for patients returning home from hospital.
“They never felt alone in the initial stages of their discharge,” she said.
CFHI reports the program costs about $1,000 per patient per year to implement, but over the next five years would net $263 million in savings on COPD-related hospital care in Ontario alone. Langdon told the Star he hasn’t visited the hospital for COPD-related care since completing the program. He’s since mastered exercises that can be performed sitting down and can use the “little blue inhalers” he keeps in the kitchen, bedroom and TV room with ease.
“This gave my life back,” he said. “I sleep at night and I breathe fine.”