Continued Care for COVID Recovery: How LTAC Hospitals Help Post-COVID Patients

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<p>The latest research findings are honing in on the clinical conditions associated with COVID-19, along with the specific care pathways needed for patients, once stabilized, to fully recover. Specialized care after the initial hospital stay is proving to play a critical role.&nbsp;</p>
<p>Hospitalized COVID-19 patients often experience significant pulmonary complications, including severe pneumonia and acute respiratory distress-like syndrome. Further, many physicians are reporting that patients are developing post-intensive care syndrome (PICS) due to an intensive care unit (ICU) stay measured in weeks rather than days. The virus is also resulting in strokes, and causing sepsis, which can lead to multi-system failure and leave a patient with lasting damage to the lungs and other organs.</p>
<p><strong>This brief details COVID-19 patient care management strategies and research on how the clinical expertise of LTAC hospitals is uniquely suited for post-COVID patients.</strong></p>
<h2><strong>New Research on Care Solutions for Post-COVID Patients: The Role of LTACHs</strong></h2>
<p>A growing body of evidence indicates that the specialized services delivered in long-term acute care hospitals play a unique and positive role in treating patients recovering from COVID-19.</p>
<p>A recent study in the <em>Journal of Rehabilitative Management</em> stated that: &ldquo;Early rehabilitation of the COVID-19 patients can enhance pulmonary, respiratory function, reduce complications, improve function, cognitive impairments and quality of life."<sup>1</sup></p>
<p>Hospitalized COVID-19 patients are receiving life-saving care in an ICU for much longer than the average stay of three to four days and are often reliant on a ventilator, both of which puts them at high risk of developing post-intensive care syndrome (PICS) &ndash; a condition that can include ICU-acquired weakness, cognitive or brain dysfunction and other mental health disorders. Specialized care interventions and rehabilitation are needed to address the short- and medium-term consequences of post-COVID patients experiencing PICS symptoms and recovering from extended mechanical ventilation.<sup>2</sup></p>
<p>Additionally, as published recently in <em>The Boston Globe<sup>3</sup></em>:</p>
<p style="padding: 0 50px;">Many recovering COVID-19 patients need to be weaned off of ventilators and slowly reintroduced to eating on their own. Some also require speech therapy, pulmonary therapy, and dialysis.</p>
<p style="padding: 0 50px;">&hellip;COVID-19 has reminded the world of the importance of facilities that occupy the middle ground of the critical care landscape.</p>
<p style="padding: 0 50px;">&ldquo;In a pandemic, you really do need that kind of intensive care,&rdquo; said Grabowski, who co-authored a paper advocating for the importance of long-term acute care hospitals. "For years, we said, &lsquo;Why do we need long-term care hospitals?&rsquo; And all of a sudden with COVID, we&rsquo;re saying &lsquo;Why don&rsquo;t we have more long-term care hospitals?&rsquo;&rdquo;</p>
<p>Lastly, a recently co-authored a post in <em>Health Affairs</em> highlighted the critical resource that LTAC hospitals can play during the COVID pandemic.<a href="#_ftn4" name="_ftnref4"></a><sup>4</sup> Specifically, the researchers suggest that <strong>the clinical expertise in LTAC hospitals with &ldquo;critical care nurses, respiratory therapists, and intensivists&rdquo; aligns with the ongoing needs of COVID patients. </strong>The experts conclude that, &ldquo;During this unprecedented international crisis, [LTAC hospitals] offer additional opportunities to prepare for and manage the surge of COVID-19 patients experiencing respiratory failure.&rdquo;</p>
<h2><strong>Unique Clinical Presentations Require Specialized Care</strong></h2>
<p>Due to the complex medical needs of post-COVID patients, long-term acute care (LTAC) hospitals are a key care setting. LTAC hospitals deliver care for the most difficult-to-treat, critically ill and medically complex patients &ndash; such as patients with respiratory failure, septicemia, traumatic injuries, wounds or other severe illnesses complicated by multiple chronic conditions, many of which have been symptoms of post-COVID recovery.</p>
<p>These specialty hospitals are unlike other post-acute care settings because they are licensed as a general acute care hospital by the state and certified by the Centers for Medicare &amp; Medicaid Services (CMS) as an LTAC hospital, and accredited by the Joint Commission under acute care standards. Additionally, care is provided in an interdisciplinary fashion, featuring daily physician visits and specialty physicians based on patient needs. Clinicians are specially trained for the critical care setting and are able to support prolonged recovery times.</p>
<h2><strong>LTACH Expertise in Pulmonary Care and Recovery</strong></h2>
<p>A patient&rsquo;s recovery and long-term lung health is directly dependent on the type and intensity of the care they receive. Distinct from all other post-acute settings, LTAC hospital clinicians are highly specialized in their ability to successfully liberate the most challenging ventilator patients, and LTAC hospitals feature hospital-level infection control, negative pressure rooms where needed and on-site laboratories and dialysis.</p>
<h2><strong>How Kindred Hospitals Can Help</strong></h2>
<p>We specialize in the treatment and rehabilitation of the post-intensive care and complex medical patient requiring continued intensive care, including specialized rehabilitation, in an acute hospital setting.</p>
<p>Our team of skilled and caring clinicians in our long-term acute care hospitals can be the right partner for you for your patients who have been in an ICU or a critical care unit, or who are chronically ill and readmit to the hospital frequently. We have proven success in treating patients with pulmonary disease and respiratory failure, including a long history of liberating patients from mechanical ventilation and artificial airways.</p>
<p>Many of our hospitals have or are in the process of achieving disease-specific certification from The Joint Commission in key conditions such as respiratory failure and sepsis.</p>
<p>We also have decades of experience treating post-intensive care syndrome (PICS). Under Kindred&rsquo;s expert interdisciplinary care, patients receive targeted services including:</p>
<ul>
<li>Daily physician oversight</li>
<li>Physician specialists</li>
<li>ICU-level care and staffing when necessary</li>
<li>24/7 respiratory therapy coverage</li>
<li>IV pain control management and narcotic/opioid weaning</li>
<li>Early mobilization of both ventilated and spontaneously breathing patients</li>
<li>Antimicrobial management to complete sepsis treatment and prevent antibiotic resistance</li>
<li>Interdisciplinary teams to clarify interventions and monitor progress</li>
<li>A patient-centered, goal-directed care plan addressing function, cognition and medical impairments</li>
<li>Family-focused discharge planning, whether directly to home or to less intense levels of post-acute care</li>
</ul>
<p><strong>If you have a post-COVID patient, or other patients in need of care after a hospital stay, call a Kindred Clinical Liaison for a patient assessment. Our experts will help you determine the most appropriate care setting for your patient&rsquo;s next stage of treatment. If you are unsure of who your Kindred representative is, please feel free to <a href="https://www.kindredhealthcare.com/our-services/transitional-care-hospitals/healthcare-professionals" target="_blank">contact us</a>&nbsp;and speak with a Registered Nurse who can assist.</strong></p>
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<p>References</p>
<ol>
<li><span style="font-size: 12px;">Fary Khan, MBBS, MD, FAFRM (RACP), Bhasker Amatya, DMedSci, MD, MPH, <em>&ldquo;Medical Rehabilitation in Pandemics: Towards a New Perspective,&rdquo;</em> Journal of Rehabilitative Management, Vol. 52, Issue 4, April 9, 2020</span></li>
<li id="ftn2">
<p><span style="font-size: 12px;">Stam HJ, Stucki G, Bickenbach J. Covid-19 and Post Intensive Care Syndrome: A Call for Action. J Rehabil Med. 2020;52(4):jrm00044. Published 2020 Apr 15. doi:10.2340/16501977-2677</span></p>
</li>
<li id="ftn3">
<p><span style="font-size: 12px;">Dasia Moore, "COVID-19 patients are recovering, but with nowhere to go," The Boston Globe, May 19, 2020</span></p>
</li>
<li><span style="font-size: 12px;"><em>&ldquo;How Can We Ramp Up Hospital Capacity To Handle The Surge Of COVID-19 Patients? Long-Term Acute Care Hospitals Can Play A Critical Role,&rdquo;</em> Health Affairs blog, April 13, 2020, DOI: 10.1377/hblog20200410.606195</span></li>
</ol>
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Reducing Respiratory Failure Readmissions While COPD Is on the Rise

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<a class="btn btn-blue _gt" data-category="Hospital" data-action="Click-Button" data-label="Blog-Reducing Respiratory Failure Readmissions While COPD Is on the Rise" href="https://www.kindredhealthcare.com/docs/default-source/default-document-library/kindred-respiratory-failure-whitepaper.pdf?sfvrsn=74f58dea_2" title="Reducing Respiratory Failure Readmissions While COPD Is on the Rise" target="_blank">Download this article as a PDF</a></div>
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<p>Diagnoses of Chronic Obstructive Pulmonary Disease (COPD) have been on the rise since the early 2000s. By 2030, it is projected to be the third most common cause of death, according to the World Health Organization. It&rsquo;s already the third most common reason for hospital readmission.</p>
<p>In order to encourage health systems to improve outcomes for COPD patients, the Centers for Medicare and Medicaid Services (CMS) included COPD in the Hospital Readmissions Reduction Program (HRRP) back in 2014, which can penalize hospitals for excessive 30-day readmissions in an effort to encourage providers to tackle the problem. However, five years later, few published COPD readmission reduction programs have emerged, leading to continued inconsistency across health systems and little movement in the readmission rate.</p>
<p>Without innovative action, the care costs of COPD in today&rsquo;s value-based care world will rise right along with its prevalence.<strong> In this whitepaper, we examine the strategies providers and physicians should consider to help improve outcomes and reduce costly readmissions for this at-risk population.</strong></p>
<p><strong><img src="https://www.kindredhealthcare.com/images/default-source/blog-images/the-kindred-continuum/hd-respiratory-failure-infographic-copd.jpg?sfvrsn=55f98dea_0" data-displaymode="Original" alt="Infographic: COPD is projected to go from the 5th-most common cause of death in the U.S. to the 3rd by 2030. COPD is the 3rd-most common reason for hospital readmission." title="Infographic: COPD is projected to go from the 5th-most common cause of death in the U.S. to the 3rd by 2030. COPD is the 3rd-most common reason for hospital readmission." /></strong></p>
<h2><strong>The COPD Problem</strong></h2>
<p>COPD incidence is on the rise, and fast. Here are the stats:</p>
<ul>
<li>COPD is projected to go from the fifth-most common cause of death in the U.S. to the third by 2030.</li>
<li>COPD is the third-most common reason for hospital readmission.</li>
<li>Thirty-day hospital readmissions related to COPD are high, at 22%.</li>
<li>For patients who require ICU treatment for COPD, the ICU readmission is even higher&mdash;about 25%.</li>
<li>COPD is often a multimorbidity. By 2030, about 40% of people 65 and older will suffer from three or more chronic conditions. Recognizing this, COPD is now described as a syndrome rather than a single disease.</li>
</ul>
<p>This is creating a surge in demand for acute-care facilities that have the ability to successfully treat these medically complex and seriously ill patients, particularly those in need of assistive breathing devices.&nbsp;</p>
<h2><strong>Improving COPD Outcomes</strong></h2>
<p>While no single readmission reduction program has emerged as superior, individual hospitals have been implementing their own best practices in an effort to avoid CMS penalties. Here are a few case studies and the most impactful strategies providers could consider for their own care enhancements. </p>
<p><strong>An emphasis on care management.</strong> One 200-bed community hospital employed a dedicated COPD care manager to communicate with patients, document care plans, facilitate referrals and visit patients at home two to three days after discharge. After a year, hospital administrators credited this care management program with a drastic decline in COPD readmissions&mdash;from 12% to 6.7%. </p>
<p>Meanwhile, an 800-bed university hospital in the same health system chose to implement standardized electronic treatment pathways and readmission risk calculations. The academic hospital recorded only modest reductions in COPD readmissions at the year mark, citing low utilization and rigid order sets as the reasons. </p>
<p><strong>Multidisciplinary focus on COPD.</strong> An academic hospital in an underserved area took aim at CMS HRRP by taking a page out of other chronic disease handbooks, assembling an interprofessional team focused on COPD. Led by a dedicated, advanced-practice nurse, the team developed a systematic approach to ensure all patients admitted to the hospital with COPD received a pulmonary consultation. After comparing data from six months prior to the program implementation and six months after, they found that COPD readmissions dropped nearly 50%. </p>
<p><strong>Referral to pulmonary rehabilitation.</strong> In a review for a joint statement by the American Thoracic Society and the European Respiratory Society, researchers found mixed results in pulmonary rehabilitation&rsquo;s effect on 30-day, all-cause readmission rates but a nearly 50% reduction in readmissions in the long term. This is unsurprising considering pulmonary rehab typically is conducted over a period of weeks, or even months. These results indicate that pulmonary rehab is essential to long-term readmission reduction and patient outcomes. </p>
<p><strong>Identification of high-risk patients.</strong> To date, there is only one tool available to help providers
predict readmission risk specifcally among COPD patients.
The PEARL (previous admissions, eMRCD score, age, rightsided and left-sided heart failure) score was designed to and has
proven succesful in identifying patients at risk for readmission
within 90 days. But currently there is no model available for
30-day readmissions, which means there is still ample room for
improvement when it comes to identifying at-risk patients. </p>
<p>Until an evidence-based readmission reduction program emerges as the clear solution for COPD patients, it will be up to each acute-care hospital to design and implement a protocol that works for their organization and patient population.&nbsp;</p>
<h2><strong>The Role LTAC Hospitals Play in Care for COPD Patients</strong></h2>
<p>Another key strategy for hospitals and health systems to consider to aid in reducing readmissions for COPD patients is to identify downstream partners who are experts in caring for complex pulmonary patients &ndash; such as long-term acute care (LTAC) hospitals.</p>
<p>LTAC hospitals are in a unique position to care for COPD patients because they provide acute-level care to chronically, critically ill patients, with a particular competency for those with pulmonary issues. Further, the vast majority of COPD patients have multiple comorbidities, meaning they would benefit from seeing a physician or several specialty physicians every day, something LTAC hospitals offer.</p>
<p>While LTAC hospitals provide care for a very high-acuity, niche patient population, they play a vital role in achieving the efficient recovery of patients who have a high risk of readmission due to their clinical complexity. By transitioning these challenging patients to an LTAC hospital when it is the most appropriate site of care for their needs – rather than a skilled nursing facility or other post-acute care site – readmission rates can be lowered, patient outcomes can be improved and a significant portion of financial losses can be mitigated.</p>
<p>It is important for providers and physicians to identify partners who can provide expert care for complex pulmonary patients to help reduce readmissions and avoid penalties.&nbsp;</p>
<h2><strong>How Kindred Can Help Your COPD Patients</strong></h2>
<p>Acute care providers need partners who can continue to provide physician-directed care with the extended recovery time COPD patients&mdash;particularly those on mechanical ventilation &mdash;require. Kindred Hospitals specialize in the treatment of patients with complex medical issues who require intensive care and pulmonary rehabilitation in an acute hospital setting. With daily physician oversight, ICU- and CCU-level staffing, 24/7 respiratory coverage and specially trained caregivers, we work to improve functional outcomes, reduce costly readmissions and help patients transition home or to a lower level of care.</p>
<p><img src="https://www.kindredhealthcare.com/images/default-source/blog-images/the-kindred-continuum/hd-respiratory-failure-infographic.jpg?sfvrsn=a7f98dea_0" data-displaymode="Original" alt="Daily physician oversight, ICU-and CCU- level staffing, 24/7 respiratory coverage, Specially trained caregivers" title="Infographic: Daily physician oversight, ICU-and CCU- level staffing, 24/7 respiratory coverage, Specially trained caregivers" /></p>
<p>We are committed to pursuing innovations in care delivery and payment models to provide new tools and solutions to our patients and their families as well as to our provider and payer partners. Many of these resources and initiatives are designed to ensure efficient care management for each patient.</p>
<p>One such initiative is our effort to achieve <strong>disease-specific certification from The Joint Commission for Respiratory Failure</strong> in all Kindred Hospitals across the country. The certification recognizes healthcare organizations that provide comprehensive clinical programs across the continuum of care for respiratory failure. It evaluates how organizations use clinical outcomes and performance measures to identify opportunities to improve care, as well as to educate and prepare patients and their caregivers for discharge.</p>
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<p>Check out this video featuring our hospital teams in Houston who have successfully achieved certification from The Joint commission.
</p>
<div class="responsive-video"><iframe src="https://www.youtube.com/embed/Y98zFccW3_4?rel=0" title="Kindred Hospitals: Specialists in Caring for Patients with Respiratory Failure" allowfullscreen="true"></iframe></div>
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<p>We have proven success in treating patients with pulmonary disease and respiratory failure, including a long history of liberating patients from mechanical ventilation and artificial airways. Our program structure and management protocol include:</p>
<ul>
<li>A review of every new admission for potential inclusion in the Respiratory Failure Program based on qualifying criteria</li>
<li>Focused interdisciplinary care team and ventilator rounds for program participants</li>
<li>Development of an individualized plan of care and creation of interdisciplinary goals targeting the patient&rsquo;s pulmonary needs</li>
<li>Daily multidisciplinary assessment, evaluation, treatment and therapy following established clinical practice guidelines for:
<ul>
<li>Ventilator liberation</li>
<li>Early mobility</li>
<li>Oral care </li>
<li>Maintenance of skin integrity</li>
</ul>
</li>
<li>Disease-specific education for patients and their families while enrolled in the Respiratory Failure Program.</li>
<li>Structured performance measure and patient perception data tracking to assess and assure program quality and ongoing success</li>
</ul>
<p>Additional care delivery innovations that help improve care for our respiratory failure patients include the <strong>AfterCare</strong> program and the <strong>Move Early </strong>mobility program. The AfterCare program features Registered Nurses telephonically reaching out to patients who discharge from our hospitals directly home, on a scheduled timeline, in order to identify and manage clinical gaps and medication regimens to prevent patient decline or rehospitalizations. The Move Early program aims to get patients moving as early in their recovery &ndash; including those on mechanical ventilation — as possible to combat the many potential, and detrimental, side effects of immobility in the healing process. </p>
<p><strong>Learn more about these programs:</strong></p>
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<p><strong>Reducing Rehospitalizations Through Early Patient Mobilization</strong></p>
<p><a href="https://www.kindredhealthcare.com/resources/blog-kindred-continuum/2019/02/01/reducing-rehospitalizations-through-early-patient-mobilization" target="_blank"><img src="https://www.kindredhealthcare.com/images/default-source/blog-images/the-kindred-continuum/reducing-rehospitalizations-thumb.png?sfvrsn=8ff48dea_2" data-displaymode="Original" alt="Reducing Rehospitalizations Through Early Patient Mobilization" title="Reducing Rehospitalizations Through Early Patient Mobilization" /></a></p>
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<p><strong>Improve Patient Outcomes through Post-Discharge Virtual Care</strong></p>
<p><a class="_gt" data-category="Hospital" data-action="Click-Thumb" data-label="WP-Improve Patient Outcomes through Post-Discharge Virtual Care" href="https://www.kindredhealthcare.com/resources/blog-kindred-continuum/2019/06/24/improve-patient-outcomes-through-post-discharge-virtual-care" target="_blank"><img src="https://www.kindredhealthcare.com/images/default-source/blog-images/the-kindred-continuum/postdischargevirtualcare-thumb.png?sfvrsn=cafb8dea_2" data-displaymode="Original" alt="Improve Patient Outcomes through Post-Discharge Virtual Care" title="Improve Patient Outcomes through Post-Discharge Virtual Care" height="227" /></a>
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<p>&nbsp;</p>
<p>In today&rsquo;s value-based care environment, and as more people develop COPD, we are committed to treating chronically, critically ill patients and to continued clinical growth with specific expertise in pulmonary care.</p>
<p><strong>To learn more about how Kindred Hospitals can help care for your chronically, critically ill patients, visit <a href="https://www.kindredhealthcare.com/our-services/transitional-care-hospitals" target="_blank">kindredhospitals.com</a>.</strong></p>
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<p>References:&nbsp;</p>
<ol>
<li>
<a href="#" class="marketo-modal modal-popup" data-marketotitle="Sign up to keep on top of the latest news, trends and best practices in healthcare, post-acute care and more" data-marketoformid="1536" data-marketosuccessmessage="Thank you for your submission." data-marketomodalbackground="modal-kindredblue-theme" data-marketomodallayout="marketo-modal-form" data-popupoptions="AutoLoadForNewUsers">Sign up to keep on top of the latest news, trends and best practices in healthcare, post-acute care and more</a>
<span style="font-size: 12px;">Atsjournals.org. (2019). Reducing Chronic Obstructive Pulmonary Disease Hospital Readmissions. An Official American Thoracic
Society Workshop Report | Annals of the American Thoracic Society. [online] Available at: https://www.atsjournals.org/doi/abs/10.1513/
AnnalsATS.201811-755WS [Accessed 25 Oct. 2019]. </span></li>
<li><span style="font-size: 12px;">Who.int. (2019). WHO | Burden of COPD. [online] Available at: https://www.who.int/respiratory/copd/burden/en/ [Accessed 25 Oct.
2019].</span></li>
</ol>
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