Obstructive Lung Diseases: Airways 1 |

Results of a Resident-Led Quality Improvement Project on Care of Patients With COPD in an Internal Medicine Resident Teaching Clinic FREE TO VIEW

Robert Burkes, MD; Takudzwa Mkorombindo, MD; Udit Chaddha, MD; Alok Bhatt, MD; Nancy Kubiak, MD; Karim El-Kersh, MD; Rodrigo Cavallazzi, MD
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University of Louisville, Louisville, KY

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):829A. doi:10.1016/j.chest.2016.08.929
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SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM

PURPOSE: Misdiagnosis and guideline-discordant care of chronic obstructive pulmonary disease (COPD) is not uncommon in the primary care setting. Further, there has been a push to incorporate quality improvement (QI) training into internal medicine residency curricula. Our group sought to assess if a resident-led QI project could improve the rate of guideline-based care provided to COPD patients seen in an internal medicine resident teaching (AIM) clinic.

METHODS: Pre-intervention rates of quality measure adherence were determined by review of the records of 451 AIM clinic patients with a billing code of COPD from 2010-2014. Smoking cessation counseling, pneumococcal vaccination, and diagnosis of COPD by spirometry or pulmonary function testing (PFT) were identified as measures requiring improvement. A resident-led QI intervention was initiated, consisting of a 15-minute PowerPoint presentation on COPD quality measures, an e-mail to residents presenting baseline performance data, and cards with quality targets posted in the resident teaching clinic. Adherence to the above quality measures in the subsequent 119 patients following QI intervention with a diagnosis of COPD was assessed and compared to pre-intervention data. Stata 10 (Stata Corp, College Station, Texas) was used for statistical analysis and P value < 0.05 was considered statistically significant.

RESULTS: Smoking cessation counseling was offered to 86.6% of patients after QI intervention, compared to 81.8% pre-intervention (p = 0.360). The rate of pneumococcal vaccination improved to 72.3% from 61% in the pre-intervention cohort (p = 0.024). There was a non-significant trend towards an increase in the number of patients diagnosed COPD who underwent spirometric testing to 74.8% post-intervention from 66.5% (p = 0.085).

CONCLUSIONS: One cycle of resident-led QI significantly improved the rates of pneumococcal vaccination provided to COPD patients in an internal medicine residents’ teaching clinic. There was a non- significant trend towards improvement in using spirometry or PFTs in diagnosis of COPD and offering smoking cessation counseling to active smokers.

CLINICAL IMPLICATIONS: The above QI project performed by a group of internal medicine residents demonstrates measurable improvement in the quality of care of COPD patients amongst their peers. This is important in promoting increased adherence to COPD guidelines overlooked in general medicine practice. Our study also demonstrates a successful QI project developed by and directed at internal medicine trainees.

DISCLOSURE: The following authors have nothing to disclose: Robert Burkes, Takudzwa Mkorombindo, Udit Chaddha, Alok Bhatt, Nancy Kubiak, Karim El-Kersh, Rodrigo Cavallazzi

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