Expanding The INSPIRED COPD Outreach Program^TM to the emergency department: a feasibility assessment

Abstract

BackgroundThe Halifax-based INSPIRED COPD Outreach Program™ is a facility-to-community home-based novel clinical initiative that through improved care transitions, self-management, and engagement in advance care planning has demonstrated a significant (60%–80%) reduction in health care utilization with substantial cost aversion. By assessing the feasibility of expanding INSPIRED into the emergency department (ED) we anticipated extending reach and potential for positive impact of INSPIRED to those with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) who avoid hospital admission.MethodsPatients were eligible for the INSPIRED-ED study if >40 years of age, diagnosed with AECOPD and discharged from the ED, willing to be referred, community dwelling with at least one of: previous use of the ED services, admission to Intermediate Care Unit/Intensive Care Unit, or admission to hospital with AECOPD in the past year. We set feasibility objectives for referral rates, completion of action plans, advance care planning participation, and reduction in ED visit frequency.ResultsReferral rates were 0.5/week. Among eligible patients (n=174) 33 (19%) were referred of whom 15 (M=4, F=11) enrolled in INSPIRED-ED. Mean (SD) age was 68 (7) years, post-bronchdilator FEV1 44.2 (15.5) % predicted, and Medical Research Council (MRC) dyspnea score 3.8 (0.41). We met feasibility objectives for action plan and advance care planning completion. Frequency of subsequent ED visits fell by 54%. Mean (SD) Care Transition Measure (CTM-3) improved from 8.6 (2.0) to 11.3 (1.3), P=0.0004, and of 14 patients responding 12 (86%) found the program very helpful. An additional 34 patients were enrolled to our regular program from those referred but ineligible for INSPIRED-ED (n=27) or unwilling to participate (n=7).ConclusionsINSPIRED-ED outcomes were generally positive, however referral and enrollment rates were lower than anticipated. Despite the potential of early self-management education, the ED may not be the ideal recruitment setting for home-based programs. Our findings underline the importance of conducting preliminary work to ascertain best settings for implementing new self-management education initiatives.

Spreading improvements for advanced COPD care through a Canadian Collaborative

“…Four teams used the COPD Assessment Tool (CAT), 22 which assesses the impact of COPD on a patient’s health status, and five teams chose a version of the Hopes and Expectation tool used in Halifax. 16 Teams used a variety of outcome measures to assess efficiency of health care, eg, ED visit rate (n=12), average length of stay (n=13), and unplanned AECOPD read-missions (n=12). In the same way, teams relied on a variety of measures to assess appropriateness of care ( Table 2 ).…”

“…Regarding patient and family-centeredness, some teams collected qualitative data using the Hopes and Expectations Questionnaire, a five-item questionnaire used in a recent Halifax study 16 that assesses patients’ expectations pre–post INSPIRED. To measure changes in the quality of coordination of care, teams used the validated three-item Care Transitions Measure (CTM-3).…”

“… 19 Accordingly, we used a mixed-methods approach as we have in other related research studies. 16 , 20 …”

Effectiveness and implementation of palliative care interventions for patients with chronic obstructive pulmonary disease: A systematic review

“…Adopting person Barrier 44,51,58 Referrers were not aware that the service existed, which hampered referral of patients to the innovation. 44…”

The effectiveness of intermediate care including transitional care interventions on function, healthcare utilisation and costs: a scoping review

“…Intermediate care including transitional care services are models of care that support the integration and continuity of care as well as prevention of avoidable admissions to hospital [ 1 – 3 ]. They have a particular importance in preventing the onset and progression of frailty and functional decline in adults, particularly older adults [ 4 , 5 ] since they provide comprehensive geriatric assessment, enablement and rehabilitation aimed at optimising independence and recovery [ 4 – 6 ].…”