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Scope of Practice:

Patients and caregivers require effective training to manage changes in patient conditions. Patients with respiratory system diagnosis are a significant percentage of the total episodes in home care. The patients and families in this group often need specialized teaching and monitoring to achieve improved outcomes and an appropriate degree of independence.

Respiratory Therapists can provide additional staffing flexibility when caring for patients and families with respiratory system diagnosis. Additionally, Respiratory Therapists can be an excellent resource for staff education in the care of select patients and as an active member of the performance improvement groups participating in the processes to improve selected outcomes.

Utilizing Respiratory Therapists in cases where their education, skills and scope of practice are appropriate and give agencies another tool to meet patients needs and control costs through greater flexibility in resource utilization.

Outcome Measures Specific to Respiratory Therapists:

The decision to utilize Respiratory Therapists in home care should be approached using a performance improvement (PI) or continuous quality improvement (CQI) model. The model involves actively reviewing outcomes data, using that data to identify both successes and opportunities for improvement, determining underlying reasons and best practices, selecting target outcomes, and establishing implementing plan of action.

National data suggests that primary diagnosis start of care involving the respiratory system make up 8% of all home care admissions. Outcomes and quality tracking data suggest those patients with a respiratory system diagnosis experience more emergency room visits and hospital admissions for emergent care than the average for all patients in the data. Further review of specific diagnosis including asthma and a group of diagnoses that cover several chronic obstructive lung diseases (COPD) also indicate a higher percentage of patient’s experienced emergent care or were hospitalized for emergent care during the study time frame. Finally, and certainly not unexpected, patients with respiratory system diagnoses are much more likely to be admitted for respiratory problems.

Respiratory Therapists with advanced education and practical experience in respiratory systems are a valuable resource for evaluating and improving the care of patients with respiratory system diagnoses and could be utilized as a part of an overall plan to reduce emergence care and hospital readmission in this group of patients.

Respiratory Therapists can play an important role in the balance of outcomes improvement and resource utilization in home care.

Conclusion:

Hospitals will continue to employ more than 8 out of 10 Respiratory Therapists, but a growing number of therapists will be utilized by home health agencies as an additional resource to improve outcome performance. The number of patients presenting with respiratory system diagnose is expected to increase as the population ages and the need for the skills of respiratory home care agencies and organizations that deal with in home patients using an Outcomes Based Quality Improvement (OBQI) model can identify target outcomes and consider the most appropriate resources to achieve improvement consistent with a mindset of balancing costs and quality. Respiratory Therapists can play an important role in the balance of outcomes improvement and resource utilization in home care services.