The Effect of Respiratory Therapist Case Managers Integrated into COPD Clinical Care

Background: Personalized education and treatment selection can improve health behaviors and outcomes in patients with COPD. However, many patients with COPD have incomplete knowledge of their disease, which leads to undertreated symptoms. We hypothesized that an interdisciplinary care approach to COPD with respiratory therapists (RTs) integrated in our dedicated clinic will significantly affect care as measured by COPD Assessment Test (CAT) scores, exacerbation rates, and COPD-related hospitalizations. Methods: This study was a retrospective analysis of patients enrolled in the UC Davis Comprehensive COPD Clinic registry. Between January 2018-January 2020, 241 patients were seen. Patients screened (n = 101) had been followed 12 months post initial COPD clinic visit. Two subjects were excluded from analysis due to discrepancies in CAT assessments, leaving 99 subjects in total. The clinic RT provided assessment, education, and treatment recommendations. We collected CAT scores, exacerbation rates, and those that required hospitalization in the 12 months prior to and after the initial COPD clinic visit. Analysis for CAT is reported as median and interquartile range (IQR), with differences determined by Wilcoxon test. Summary data are reported as percentages, 95% CI, and chi-square test. Results: The initial median CAT score was 22 (IQR 7-34), and 2-month follow-up CAT median was 19 (IQR 11-24, P < .001). There were 115 exacerbations in the 12-month period prior to the initial clinic visit and 63 exacerbations in the 12 months post clinic visit (P = .006). In the 12-month period prior to the clinic visit, there were 44 hospital admissions for COPD exacerbations compared to 20 hospital admissions for COPD exacerbations in the 12 months after initial clinic visit (P = .06). Conclusions: Our retrospective study demonstrated significant improvements in symptoms and exacerbation rates and a non-significant reduction in hospitalizations for COPD. This suggests that an RT-facilitated program may improve meaningful clinical outcomes.