From the Mobile Integrated Health and Emergency Medicine Department, South Shore Health, Weymouth, MA.
Objective: To develop a process through which Mobile Integrated Health (MIH) can treat patients with chronic obstructive pulmonary disease (COPD) at high risk for readmission in an outpatient setting. In turn, South Shore Hospital (SSH) looks to leverage MIH to improve hospital flow, decrease costs, and improve patient quality of life.
Methods: With the recent approval of hospital-based MIH programs in Massachusetts, SSH used MIH to target specific patient demographics in an at-home setting. Here, we describe the planning and implementation of this program for patients with COPD. Key components to success include collaboration among providers, early follow-up visits, patient education, and in-depth medical reconciliations. Analysis includes a retrospective examination of a structured COPD outpatient pathway.
Results: A total of 214 patients with COPD were treated with MIH from March 2, 2020, to August 1, 2021. Eighty-seven emergent visits were conducted, and more than 650 total visits were made. A more intensive outpatient pathway was implemented for patients deemed to be at the highest risk for readmission by pulmonary specialists.
Conclusion: This process can serve as a template for future institutions to treat patients with COPD using MIH or similar hospital-at-home services.
Keywords: Mobile Integrated Health; MIH; COPD; population health.
It is estimated that chronic obstructive pulmonary disease (COPD) affects more than 16 million Americans1 and accounts for more than 700 000 hospitalizations each year in the US.2 Thirty-day COPD readmission rates hover around 22.6%,3 and readmission within 90 days of initial discharge can jump to between 31% and 35%.4 This is the highest of any patient demographic, and more than half of these readmissions are due to COPD. To counter this, government and state entities have made nationwide efforts to encourage health systems to focus on preventing readmissions. In October 2014, the US added COPD to the active list of diseases in Medicare’s Hospital Readmissions Reduction Program (HRRP), later adding COPD to various risk-based bundle programs that hospitals may choose to opt into. These programs are designed to reduce all-cause readmissions after an acute exacerbation of COPD, as the HRRP penalizes hospitals for all-cause 30-day readmissions.3 However, what is most troubling is that, despite these efforts, readmission rates have not dropped in the past decade.5 COPD remains the third leading cause of death in America and still poses a significant burden both clinically and economically to hospitals across the country.3