Spreading improvements for advanced COPD care through a Canadian Collaborative

Abstract

BackgroundA year-long pan-Canadian quality improvement collaborative (QIC) led by the Canadian Foundation for Healthcare Improvement (CFHI) supported the spread of the successful Halifax, Nova Scotia-based INSPIRED COPD Outreach Program™ to 19 teams in the 10 Canadian provinces. We describe QIC results, addressing two main questions: 1) Can the results of the Nova Scotia INSPIRED model be replicated elsewhere in Canada? 2) How did the teams implement and evaluate their versions of the INSPIRED program?MethodsCollaborative faculty selected measures that were evidence-based, relatively simple to collect, and relevant to local context. Chosen process and outcome measures are related to four quality domains: 1) patient- and family-centeredness, 2) coordination, 3) efficiency, and 4) appropriateness. Evaluation of a complex intervention followed a mixed-methods approach.ResultsMost participants were nurse managers and/or COPD educators. Only 8% were physicians. Fifteen teams incorporated all core INSPIRED interventions. All teams carried out evaluation. Thirteen teams actively involved patients and families in customized, direct care planning, eg, asking them to complete evaluative surveys and/or conducting interviews. Patients consistently reported greater self-confidence in symptom management, a return to daily activities, and improvements to quality of life. Twelve teams collected data on care transitions using the validated three-item Care Transitions Measure (CTM-3). Twelve teams used the Lung Information Needs Questionnaire (LINQ). Admissions, emergency room visits, and patient-related costs fell substantially for two teams described in detail (combined enrollment 208 patients). Most teams reported gaining deeper knowledge around complexities of COPD care, optimizing patient care through action plans, self-management support, psychosocial support, advance care planning, and coordinating community partnerships.ConclusionQuality-of-care gains are achievable in the short term among different teams across diverse geographical and social contexts. A well-designed, adequately funded public–private partnership can deliver widespread beneficial outcomes for the health care system and for those living with advanced COPD.

<p>Information Needs in COPD After an Educational Programme: Influence in Exacerbations and Admissions</p>

“…It aims to achieve a proactive attitude towards their pathology, but its influence on clinical results has not been sufficiently investigated. This study has found that our educational program is similar in terms of educational results to programs carried out in other countries such as Canada or Sweden; 11 – 13 despite the fact that patients included in our study, had a recent diagnosis and had not received information previously about their disease. The domains of the questionnaire in which patients have the greatest IN are “Diet” and “Self-care”.…”

“…The Lung Information Needs Questionnaire (LINQ) 9 is a self-administered questionnaire consisting of 16 questions divided into 6 domains: Knowledge about the disease, medications, self-management, exercise, diet and smoking. It has been used to evaluate respiratory rehabilitation programs, 10 in other types of educational programs for patients with COPD in outpatient clinics 11 , 12 or during hospital admissions. 13 This questionnaire has been previously validated 9 and translated into several languages including Spanish.…”

Palliative care as an emerging role for respiratory health professionals: Findings from a cross-sectional, exploratory Canadian survey

“…Examples of novel services include: patient-centred medical homes [37], breathlessness services that provide early access to palliative care [38, 39], and an Advanced Lung Disease Service [40]. Within Canada, the INSPIRED COPD Outreach Program TM [41] and the subsequent pan-Canadian care collaborative [42] reported rapid changes to work practices, cultural change, and skills sets at relatively low cost. Common to these new programs is an interdisciplinary approach.…”

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

“…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?…”