Multidisciplinary Approach Developed for COPD Pathway Patients

Quality Improvement

A computerized pathway for managing patients with chronic obstructive pulmonary disease (COPD), described in a Research, Innovations, and Clinical Vignettes poster/abstract presented at HM13, brings together evidence-based computerized physician order entry order sets for managing COPD with links to pulmonology and respiratory therapy protocols, and with established care transitions processes at the University of California at San Diego.¹

“When I started this journey, examining how we were doing in adhering to national and international guidelines for COPD care, it turned out we were not doing such a great job,” says lead author Weijen Chang, MD, SFHM, FAAP, who works as a med-peds hospitalist at UCSD and is pediatric editor of The Hospitalist. “We were providing ideal care as defined in the guidelines only about 60 percent of the time.”

Dr. Chang found that UCSD pulmonologists were simultaneously working on their own QI project, so they combined forces around a COPD Inpatient Care Workgroup comprising hospitalists, pulmonologists, respiratory therapists, pharmacists, and information system specialists. The group developed a COPD Longitudinal Inpatient Pathway and Transition Pathway (CLIPT) addressing appropriate referrals for subspecialist care and rehabilitation in and out of the hospital.

The key was not just to create order sets for optimal COPD care, but also to improve access, continuity of care, and post-discharge follow-up through the pathway, which is available for initiation in the ED, at or after admission, or at discharge, Dr. Chang explains. Transition nurse specialists trained as part of a separate initiative at the medical center provide COPD case management. The group is exploring the use of respiratory therapists to actively case-manage COPD patients going home. Patients are connected with a COPD discharge clinic staffed part-time by a UCSD pulmonologist.

According to the abstract, the CLIPT pathway was initiated in 46% of patients admitted with acute exacerbations of COPD. Dr. Chang says further study is needed to assess outcomes during and after hospitalization.

More ideas on enhancing hospital care for the COPD population in order to manage their high risk of readmissions was presented at the recent COPD and Readmissions Summit sponsored by the COPD Foundation (www.copdfoundation.org) in October in Washington, D.C.

References

1. Chang W, Maynard G, Clay B. Implementation of a computerized COPD inpatient pathway and transition pathway [abstract]. J Hosp Med. 2013;8 Suppl 1:709.
2. Schmitt S, McQuillen DP, Nahass R, et al. Infectious diseases specialty intervention is associated with decreased mortality and lower healthcare costs [published online ahead of print September 25, 2013]. Clin Infect Dis.
3. Torio CM, Andrews RM. National inpatient hospital costs: the most expensive conditions by payer, 2011. Healthcare Cost and Utilization Project Statistical Brief #160. Available at: http://www.hcup-us.ahrq.gov/reports/statbriefs/sb160.jsp. Accessed October 26, 2013.
4. Herman B. Top 20 most expensive inpatient conditions. Becker’s Hospital Review. Oct. 9, 2013. Available at: http://www.beckershospitalreview.com/racs-/-icd-9-/-icd-10/top-20-most-expensive-inpatient-conditions.html. Accessed October 26, 2013.