Michigan Program Works to Put Respiratory Navigators in the Home

Sometimes, the best way to improve care is to look at it from a completely different point of view.

That’s what McLaren Lapeer Region decided to do back in 2018 when it decided to fix a problem it had with respiratory readmissions. At the time, the hospital—a 222-bed center in southeastern Michigan that’s part of the larger McLaren Health System—was experiencing readmit rates at about 27% for patients discharged with COPD.

Brian Wicker, the hospital’s director of respiratory services, decided something had to be done. He started to sketch out a program where respiratory therapists (RTs) from the hospital’s staff would venture into the homes of recently discharged patients living with COPD. This person—dubbed a respiratory navigator—would help educate patients about their care and address any complications at home, rather than the patient coming back to the emergency department
or hospital.

“Who better than to explain these respiratory medications and keep these people with COPD safe at home than a respiratory therapist?” Wicker said. “And I said sure, of course, but how do we pay for it?”

Making it Happen

He received a six-month grant from the hospital to help test out the project, and then RT Kelly Long—who was working in another department at the time—felt a “lightbulb came on with a burning passion,” and decided to join the project.

“We need to advocate and push for this, not only for our profession but for the patients,” Long said. “We take care of these patients and save them from drowning—and then we send them home.”

All these years later, the program is still going strong, now permanently funded by the hospital and incorporated into its daily practices.

And it’s showing results. In the initial grant, Wicker said, they aimed for a reduction in readmissions by 5 points or 20%. A paper that’s currently under review will reveal their full data (which they can’t fully share until then), but meanwhile, Wicker said, it’s safe to say they are hitting readmit rates in the range of 3% to 8% depending on the time frame examined.

Either way, it’s having an impact on patients and improving the hospital’s outcomes.

“It’s where we need to go with medicine, where we’re moving from sickness care to wellness care,” said Long. “We’re basically extending the walls of care from the hospital.”

Clearing the Path for Better Care

Long usually starts her day by checking the emergency room logs. If there are eligible patients, she goes to their bedside to introduce herself and asks them to join the program. Some say no the first time—but then agree when they have returned to the hospital for a second or third time.

She spends much of her days driving around their rural county in a hospital-provided van that she calls her “mobile office.”

She does spend some time checking on patients by phone but said in-person visits are the most effective.

“Telerespiratory is wonderful, but there’s things we uncover in the home,” Long said. That includes whether patients are using their equipment correctly, managing their medications and eating properly. “There’s so many things as respiratory therapists we’re able to look at (and) identify the gaps in care,” she added.

For example, she said, one recent patient was experiencing a lot of power outages. Another was sleeping right below two pet exotic birds. In some cases, a patient didn’t have oxygen bled into their BiPAP, or their pharmacist hadn’t reconciled their medications. Sometimes, Long recommends home health care be added if the person could qualify.

“Kelly gets to peel back that onion and see the whole picture,” Wicker said. “There’s a lot of things that
are missed.”

In fact, between June 2021 and June 2022, the team assisted 88 patients with 127 medical interventions ranging from increasing the capacity of their oxygen concentrator to getting them a portable oxygen concentrator to requiring a blood transfusion to referring them to hospice or
palliative care.

Long also makes sure the patient is well-educated about their disease and how to manage it, something she says is far easier to do at home than in the hospital, where people are sick and anxious, or at discharge, when they’re distracted and eager to leave. And in case they have questions or issues, they can reach her directly; Wicker said Long gives her patients her cell phone number in case of emergency.

Next Steps

Those efforts—which he said are an example of how Long goes above and beyond—help build trust between therapist and patient that’s almost impossible to do outside the home, he said.

And it’s having real results. Beyond reducing readmits, the program has also driven more than $2.4 million in downstream revenue for the hospital since it began, including in office visits, sleep studies, pulmonary rehab, blood work, diagnostic imaging, surgeries, etc.

Wicker said it’s something that could expand beyond just COPD to other respiratory diseases, and other care models.

“This is the right thing to do,” he said. “A lot of people are doing a version of it, and we need to standardize it. This can be replicated across systems.”