Rural COPD quality improvement initiative

Chronic Obstructive Pulmonary Disease (COPD) is a major and costly disease burden in the US and the prevalence is increasing. From 40% to 50% of patients with COPD discharged from hospitals are re-admitted during the following year and 17% of patients discharged from emergency departments require hospitalization. To improve the care of patients with Chronic Obstructive Pulmonary Disease (COPD) we developed and evaluated a pilot quality improvement project with funding from the HSRA Office of Rural Health Policy. This was then expanded to a two year implementation project separately funded. The Rural COPD Improvement Initiative sought to demonstrate the effectiveness of using evidence-based best practice guidelines and patient support for behavior change in the rural practice settings. We enrolled 24 primary care practices located in northern and eastern Maine into the project over the course of three years. Best practice guidelines are based on the Global initiative for Chronic Obstructive Lung Disease (GOLD); process improvement includes use of the Institute for Healthcare Improvement's (IHI) Breakthrough Series learning session model. Quality of care and patient health status is being measured before, during and after the collaborative though assessment tools designed for this purpose. Changes in practice behavior are measured by a practice infrastructure tool. Patient health improvement is measured from medical records data. Data collection also makes use of a COPD disease registry designed for the study. Additionally, practice barriers and patient barriers are identified through interviews and patient focus groups and are then addressed at the learning sessions and through direct contact with practices. The project ends June 30, 2007 after which a statewide dissemination conference on COPD treatment will be held. Improvements to date include up to an 80% increase in patients who received smoking cessation counseling at every office visit, up to a 78% increase documentation of self-management goals, a 69% increase in patients who received COPD education materials, and a 37% increase in documentation of patient spirometry results. Use of spirometry continues to be a problem due to training and equipment issues at the practice. Immediate positive impacts related to provider perceptions and care at the patient level was observed. In addition, long term-benefits are expected to include streamlined provision of COPD-related care, improved patient health status and decreased utilization of health care services due to improved self management.