Improving care for advanced COPD through practice change: Experiences of participation in a Canadian spread collaborative

Abstract

Chronic obstructive pulmonary disease (COPD) is a leading cause of death, morbidity, and health-care spending. The Halifax, Nova Scotia-based INSPIRED COPD Outreach Program™ has proved highly beneficial for patients and the health-care system. With direct investment of <$1-million CAD, a pan-Canadian quality improvement collaborative (QIC) supported the spread of INSPIRED to 19 teams in the 10 Canadian provinces contingent upon participation in evaluation. The collaborative evaluation followed a mixed-methods summative approach relying on collated quantitative data, team documents, and surveys sent to core members of the 19 teams. Survey questions included a series of multiple-choice responses, Likert scale ratings, and open-ended questions. The qualitative evaluation entailed key informant interviews and focus groups undertaken between February and April 2016 post-collaborative. Teams reported that the year-long QIC helped bring focus to a needed, though often overlooked area of improvement, facilitating innovation spread. They report examples of new work practices as well as unanticipated cultural change (given the short QIC time frame). Most teams gained new skills in quality improvement (QI) and evidence-based medicine, showing progress in their ability to measure and implement COPD care improvements. Teams felt networking with other teams across the country toward a common solution as well as learning from a team of clinical innovators and evidence-based innovation were critical to their success. Factors affecting sustainability included local leadership support, involvement of frontline clinicians, and sharing milestones to motivate continued QI. The INSPIRED QIC enabled teams across Canada to adapt and implement a new COPD care model for high users of health-care with rapid improvements to work practices, cultural change, and skill sets, and at relatively low cost.

Spreading improvements for advanced COPD care through a Canadian Collaborative

“…We describe in some detail elsewhere 17 the facilitators to program implementation and focus herein on the challenges. The majority of programs reported staff problems that included time conflicts, where employees were unable to dedicate adequate time to the improvement efforts, lack of adherence to the strategies being implemented, lack of experience/training necessary to facilitate/implement components of planned programs, and lack of commitment to the program.…”

Palliative care and management of troublesome symptoms for people with chronic obstructive pulmonary disease

“…126 Other interventions have been implemented as quality improvement programmes but not initial service evaluations suggests a reduction in unplanned hospital admissions can be achieved. 128,129 Advanced COPD clinics led by respiratory medicine with palliative care consultation only for the most complex patients have also been described, 130 entering PR about the addition of advance care planning within the programme education, and found nearly 90% desired more information about advance directives and nearly 70% wished to discuss life-sustaining treatments more explicitly with their clinical team. 131 The broader integration of palliative care into PR, could be one approach to introduce palliative care early on in illness, 132 and warrants further study.…”

Exploring role clarity in interorganizational spread and scale-up initiatives: the ‘INSPIRED’ COPD collaborative

“…The implementation of the INSPIRED COPD Collaborative occurred between Sept 2014 and Sept 2015. A previous study examining general team processes, health outcomes, context, participant perspectives, partnerships, program reach, and sustainability in the INSPIRED COPD Collaborative was conducted using final reports, surveys, key informant interviews, focus groups, and self-rating exercises [25]. Details about the data collection method can be found in a recent paper [25].…”

“…A previous study examining general team processes, health outcomes, context, participant perspectives, partnerships, program reach, and sustainability in the INSPIRED COPD Collaborative was conducted using final reports, surveys, key informant interviews, focus groups, and self-rating exercises [25]. Details about the data collection method can be found in a recent paper [25]. For the current study, notes from key informant interviews (KII) and focus groups (FG), as well as final reports (FR) from the aforementioned study were deemed sufficient to support a contextualized understanding of role development (see Table 1).…”

“…This national dissemination program was launched in September 2014 by the Canadian Foundation for Healthcare Improvement (CFHI) with support from Boehringer Ingelheim (Canada) Ltd., and engaged 19 healthcare teams across Canada. Two prior publications describe experiences of participating in the program and in the spread of the INSPIRED approach [24,25]. Building on these results and to address existing knowledge gaps, we examined role clarification in the INSPIRED COPD Collaborative to investigate two questions: i) how does the spread of QI initiatives impact role clarification, and ii) how does role clarity develop between hospital and community health organizations working together to transition patients from one system of care to another?…”