A prospective dual-cohort study of Respiratory and Palliative Care for patients with advanced lung disease

Abstract

Introduction: Advanced lung disease patients face significant barriers to accessing specialist care which could help address their high symptom burden and frequent hospital admissions. We report outcomes of a model of integrated Respiratory and Palliative Care which established both Physician Home Visit (HV) and Outpatient Clinic (OPC) capacity.

Aims: To describe the model of care and to measure the potential impact on healthcare utilisation.

Methods: This prospective observational dual-cohort trial was conducted at a tertiary teaching hospital in Australia. Patients with lung disease were referred with a high symptom burden, frequent hospital admissions, decreased function or poor prognosis. Clinical data described key tasks completed per HV and OPC review. Chi squared statistics analysed healthcare utilisation 90 days before/after the first review.

Results: Between July 2017 and March 2020, n=109 patients flexibly received 64 HV and 245 OPC reviews. Key tasks per review were higher for HV than OPC reviews with more: disease specific action plans (81% HV, 53% OPC, p=0.06); breathlessness action plans (67% HV, 63% OPC, p=0.8); advance care plans (77% HV, 31% OPC, p<0.05); medication rationalisation (98% HV, 44% OPC, p<0.01); and outpatient appointment rationalisation (63% HV, 23% OPC, p<0.01). Overall, acute hospital admissions decreased by 33% (p=0.02); cumulative total bed days by 38% (p<0.01); and outpatient attendances by 39% (p<0.01).

Conclusion: This model of integrated Respiratory and Palliative Care provided intensive, personalised OPC and HV reviews to patients with advanced lung disease, and demonstrated a decrease in acute healthcare utilisation.