Improving Quality of Care for Patients with Chronic Obstructive Pulmonary Disease

Abstract

A chronic obstructive pulmonary disease (COPD) project was initiated at 18 primary care clinical practices located in rural areas of northeastern Maine to improve the diagnosis and treatment of patients with COPD through the adoption of evidence-based and best practice clinical guidelines for care management. Clinical guidelines based on the Global Initiative for Chronic Obstructive Lung Disease (GOLD) were implemented by the practices using the Institute for Healthcare Improvement Breakthrough Series learning session model. Practice barriers and patient barriers were identified through focus groups and were then addressed at the learning sessions and through direct contact with the practices. To evaluate the improvements that were a result of the project, changes in clinical practice and patient care were measured pre and post initiative. The greatest improvements in COPD patient care were in the areas of smoking cessation counseling, annual influenza vaccinations, discussion of self-management goals, and diet/exercise counseling. Participants reported that the collaborative nature of the project allowed for mutual learning, provided teams with support to identify and overcome barriers, and fostered teamwork to find solutions to shared problems.

A rapid synthesis of the evidence on interventions supporting self-management for people with long-term conditions: PRISMS – Practical systematic RevIew of Self-Management Support for long-term conditions

“…We included two studies, 271,275 both delivered in the community, but one led by primary care physicians in rural USA, 275 and the other led from secondary care immediately after an admission (see Table 122 for details). 271 …”

“…239,240,246,258 Frequent staff turnover can be a particular challenge which needs to be addressed, 219,260,262 to ensure that skills are not lost. l Professional training in supporting self-management, [230][231][232]259 collaborative multidisciplinary working, 230,232 with good communication and referral systems between professionals, 235 and the involving staff members in the design of interventions 228,275 are potentially important ingredients of implementing self-management support. l There is a need to build relationships with existing services 263 and integrate innovation with existing practice.…”

“…l There is a need to build relationships with existing services 263 and integrate innovation with existing practice. 275 New initiatives were most warmly received by communities where there were few existing services. 263 l A team approach involving the community was seen as essential to the success of projects in deprived, minority communities.…”

“…247 Patients perception of community health-care workers as peers (as opposed to professionals) enabled them to form relationships and motivate patients to engage with their (self-) care. 257,262 l A key facilitator highlighted by several authors is the commitment of the health-care system 229,232,235,253,261,262,275 and/or local practice or clinic 236,277 with ongoing evaluation. 232 l There are practical barriers if ongoing funding or resources (including time) are insufficient to enable complex interventions to be sustained.…”

“…Specific examples which provide evidence of the effectiveness of this approach are a major national programme to improve asthma in Finland, 232 an initiative to improve asthma care in Brazil, 235 a programme to improve asthma care in Scotland, 236 COPD quality improvement programme in the USA, 275 diabetes quality improvement programmes in the USA 259 and Canada, 263 integrated stroke care in Hawaii, 278 and four studies which implemented self-management for diabetes in the context of the CCM. 237,256,262,264 Moullec et al's review 128 specifically addressed the role of setting in the context of adherence to asthma treatment by comparing RCTs which had provided one of more components of the CCM.…”