Abstract
Objectives
The Integrated Care for Advanced REspiratory Disorders (ICARE) service is a stay-in, post-acute care program for hospitalized
patients with chronic, nonmalignant lung diseases. It provides palliative rehabilitation—a
novel model integrating functional rehabilitation with early palliative care. We compare
reduction of health care utilization among ICARE participants vs matched controls
receiving usual care.
Design
This is a prospective, propensity score–matched study. Primary outcomes were reduction
in hospital readmissions and length of stay and emergency department (ED) visits,
comparing the period 6 months before and after ICARE, or 6 months before and after
hospital discharge (for controls). Secondary outcomes included 6-minute walking distance
(6MWD) and Modified Barthel Index (MBI).
Setting
Participants were matched 1:1 to controls by age, respiratory diagnosis, socioeconomic
strata, index hospitalization length of stay, frailty, and recent admissions into
intensive care unit or noninvasive ventilation units.
Methods
Multidisciplinary interventions focused on symptom relief, functional rehabilitation,
targeted comorbidity management, and postdischarge care coordination.
Results
One hundred pairs of patients were matched. Participants were older adults (mean age
73.9 ± 8.2 years) with prolonged index hospitalization (median 12.0 days; interquartile
range 7-18). Overall, 57% had high Hospital Frailty Risk Scores and 71% had overlapping
respiratory diagnoses, the most common commonest being COPD (89%), followed by interstitial
lung disease (54%) and bronchiectasis (28%). Small reductions in health care utilization
were observed among controls. ICARE was associated with a further 9.1 ± 19.9 days’
reduction in hospitalization length of stay (P < .001), 0.8 ± 1.9 lesser admission (P < .001), and 0.6 ± 2.2 fewer ED visits (P < .02). Participants with longest index hospitalization were observed to have greatest
reduction in length of stay. 6MWD and MBI scores improved by 41.0 ± 60.2 m and 12.3
± 11.6 points, respectively (both P < .001). Greater improvement was observed in patients with lower baseline 6MWD and
MBI scores. Prescription of slow-release opioids rose from 9% to 49%. Treatment for
anxiety and depression rose from 5% to 19%.
Conclusions and Implications
Integrating palliative care with postexacerbation functional rehabilitation was associated
with short-term reduction in health care utilization, improved functional capacity,
and increased treatment of dyspnea, anxiety, and depression.
Keywords
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Article info
Publication history
Published online: June 18, 2021
Footnotes
The authors declare no conflicts of interest.
Identification
Copyright
© 2021 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
