COPD Care: How Home Visits Slash Hospital Readmissions & Costs

The most dangerous thing we do as physicians? Discharge a patient from the hospital. I try to make it a little less risky—every single time.

That means checking every box:

But now, as I lean further into pulmonology, I’ve been thinking more specifically about discharge for patients hospitalized with COPD exacerbations.

One of the pillars of COPD care is preventing exacerbations. These flare-ups are deadly, costly, and highly correlated with readmissions. That’s why most hospitals have adopted COPD Care Bundles: evidence-based tools to guide acute inpatient management. We use them all the time—like clockwork.

The biggest issue, though, is that once patients leave the hospital, they’re still at high risk for readmission. And since 2015, CMS penalizes hospitals when patients with COPD are readmitted within 30 days. So yes, these readmissions are a clinical issue. But they’re a financial one, too.

Home-based care is having its moment, between hospital-at-home models and chronic care management programs. That made me wonder—could a structured, post-discharge respiratory care program at home help reduce readmissions?

I came across a promising study that looked at just that: a respiratory therapist–led home COPD disease management program. I break it down below—and explore what this could mean for future care.

The study I came across was a pre/post intervention trial from Atlantic Health System that evaluated a respiratory therapist–led COPD disease management program delivered at home. Researchers looked at patients aged 65 and older who were discharged after a COPD exacerbation. In the pre-intervention group (2016–2017), patients received standard care with no structured home follow-up. In the post-intervention group (2017–2019), patients received up to five home visits over four weeks from a respiratory therapist.

Here are some details on what the intervention included:

The results were impressive. Among 1,093 patients, 30-day readmission rates dropped from 22.3% to 12.2%. The effect persisted at 60 and 90 days, with readmissions dropping from 33.9% to 12.0% and 43.8% to 13.1%, respectively. After adjusting for demographics and smoking status, the odds of readmission remained significantly lower in the intervention group:

Of course, this was a retrospective study with the usual limitations—selection bias, demographic imbalances, and no data on readmissions to hospitals outside their network. Still, it offers a compelling case for structured, RT-led home support as a meaningful way to improve outcomes and reduce penalties for hospitals.

The juices started flowing after reading this study—and I couldn’t help but think of ways to build on it, likely at a lower cost and greater scale.

First up: telehealth. There’s no reason a respiratory therapist–led program like this needs to be entirely in-person. A hybrid approach—maybe one initial home visit followed by virtual check-ins—could preserve the clinical benefit while reducing cost and workforce burden. That’s key if we want to roll this out nationally.

Then there’s wearable tech. Devices like the Apple Watch can now track respiratory rate, oxygen saturation, and even sleep disturbances. What if we gave patients with COPD wearables to passively monitor for early signs of exacerbation—and gave RTs access to that data? They could triage who needs proactive outreach or intervention. It’s not far-fetched. We just saw this exact model tested in a 2025 JAMA RCT on asthma, where a digital asthma self-management program with wearable integration improved Asthma Control Test scores by nearly 3 points in patients with uncontrolled asthma.

COPD care could follow a similar trajectory. We already know self-management, symptom awareness, and early intervention are key to keeping patients out of the hospital. Now we just need to modernize the tools—and make them accessible to the people who need them most.

A version of this article was first seen on Healthcare Huddle.