This month’s Chair Spotlight focuses on Emil Tigas, MD, Clinician, in the Division of Pulmonary, Allergy And Critical Care Medicine. Dr. Tigas joined UMass in 2005 and in 2009 became the Medical Director for the Pulmonary Rehabilitation Program at UMass Memorial.
During this time Dr. Tigas has managed and treated many COPD patients in addition to becoming one of the few physicians specializing in chronic cough and cardiopulmonary testing with gas exchange analysis.
In 2017, Dr. Tigas became the lead physician for the COPD (Chronic Obstructive Pulmonary Disease) Readmissions Reduction Program at UMass Memorial Medical Center. COPD is a group of lung diseases characterized by reduced airflow, making it difficult to breathe and according to the CDC, COPD has been the fourth leading cause of death worldwide and is the fourth-highest for hospital readmission rates.
The COPD Readmissions Reduction Program was created in response to the Medicare Hospital Readmission Reductions Program which added COPD to its list of diseases being monitored in 2015 and the financial penalties that were proposed on hospitals for exceeding their expected readmission rates.
At inception, the program was to reduce the 30-day unplanned readmission rates for all COPD inpatients discharged from the Medical Center with the goal of improving patient outcomes, therefore, reducing financial penalties.
Dr. Tigas and his group set forth the development of the program and designed a risk assessment tool to identify high-risk COPD inpatients and providing those patients with comprehensive multidisciplinary inpatient and outpatient care. The group has applied for and been granted an Innovation Grant in the past. The grant provided funds to purchase peak inspiratory flow rate meters. This device meters evaluate a patient’s peak inspiratory flow while in the hospital and allows providers to properly select the inhaled delivery system medications that the patient should use upon discharge, optimizing inhaled medication delivery. allowing for close outpatient follow-up.
In talking with Dr. Tigas about the program he shares the program's success with the two COPD nurse practitioners, Jodi Wilson and Kaileigh Lavin, who are the backbone of the program.
How successful has the program been? In 2016 the readmission rate was 25% and since inception, the rate dropped 6.6% to 18.4% in 2020. However, with the COVID-19 dramatically changing the landscape of respiratory diseases, the program has noticed an increase in the readmission rate, which increased to 21.1%, in 2021.
Dr. Tigas does acknowledge that not all COPD inpatients are enrolled in the program and therefore doesn’t claim that the reduction in readmission rates is solely due to the program.
With the new challenges that COVID-19 brings, Dr. Tigas says the program is determined to continue with reducing readmission rates.
He recently received IRB approval for a study on COPD and exacerbation history. This 6 month-study seeks to enroll 50 patients from the Lung and Allergy Center at the University Campus. “We hope that by regularly monitoring symptoms, inhaler use, and lung function, we might be able to predict when COPD exacerbations occur”. Being able to predict when COPD exacerbations occur may allow the group to reduce readmission rates.