American College of Chest Physicians and American Thoracic Society

View all recommendations from this society

Released October 27, 2013

For patients recently discharged on supplemental home oxygen following hospitalization for an acute illness, don’t renew the prescription without assessing the patient for ongoing hypoxemia.

Hypoxemia often resolves after recovery from an acute illness, and continued prescription of supplemental oxygen therapy incurs unnecessary cost and resource use. At the time that supplemental oxygen is initially prescribed, a plan should be established to re-assess the patient no later than 90 days after discharge. Medicare and evidence-based criteria should be followed to determine whether the patient meets criteria for supplemental oxygen.


These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

This document was prepared as a joint initiative of the American College of Chest Physicians and the American Thoracic Society. A taskforce with members from both societies was selected, including individuals from diverse backgrounds and clinical areas of expertise. Taskforce members initially proposed 30 items for consideration. The taskforce debated the impact of each based on five criteria (Evidence, Prevalence, Cost, Relevance, Innovation), and agreed to narrow the list to 10 items to explore in greater depth. Following an in-depth evidence review and consultation with external content experts for each item, the taskforce together reviewed and debated the compiled information for all 10 items. Subsequently, taskforce members independently scored each item on a scale of 1–5, rating each item on its overall impact as well as on each of the five criteria. The 5 items with the best mean overall scores were retained in the “penultimate” list. The taskforce then reviewed and edited the wording of items on the penultimate list, and submitted it to both societies’ executive committees. The executive committees sought feedback from additional experts in the field, debated the items, and provided written comments to the taskforce. The taskforce deliberated and incorporated these suggestions where appropriate to create the final list, resolving any conflicts through discussion. Both Societies elected to endorse the final list.

Members of the Task Force were: Renda Soylemez Wiener, MD, MPH (Co-Chair), Scott D. Halpern, MD, PhD (Co-Chair), Daniel R. Ouellette, MD, FCCP (Co-Chair), Edward Diamond, MD, MBA, FCCP, Vincent S. Fan, MD, MPH, Janet R. Maurer, MD, FCCP, Richard A. Mularski, MD, MSHS, MCR, FCCP and Jay I. Peters, MD, FCCP.

Sources

Croxton T, Baily W, for the NHLBI working group on Long-Term Oxygen Treatment in COPD. Report of a National Heart, Lung, and Blood Institute and Centers for Medicare and Medicaid Services Workshop. Long-term oxygen treatment in chronic obstructive pulmonary disease: recommendations for future research. Am J Respir Crit Care Med. 2006;174:373–8.

O’Driscoll B, Howard L, Davison A. BTS guideline for emergency oxygen use in adult patients. Thorax. 2008;63 Suppl 6:vi1–68.

MacNee W. Prescription of oxygen: still problems after all these years. Am J Respir Crit Care Med. 2005;172:517–22.