Obstructive Lung Diseases: Airways 4 |

Reducing COPD Readmissions: Lessons Learned From a Performance Improvement Project in Kaiser Permanente Southern California FREE TO VIEW

Augusto Cam, RRT; Hector Garcia, RRT; Rene Patino, MD; Luis Moreta-Sainz, MD; Matthew Devine; Oscar Salazar; Huong Nguyen, PhD
Author and Funding Information

Kaiser Permanente Southern California, Pasadena, CA

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

Chest. 2016;150(4_S):864A. doi:10.1016/j.chest.2016.08.964
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SESSION TYPE: Original Investigation Poster

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

PURPOSE: Health systems are faced with the daunting task of adapting and implementing a large array of transitional care interventions designed to ensure the coordination and continuity of care as patients transfer between different locations and levels of care. The purpose of this study, based within one medical center of a large integrated health system with a robust electronic medical record, was to describe lessons learned from a two-year, performance improvement project that aimed to optimize care for patients admitted with a COPD exacerbation.

METHODS: We used a rapid Plan, Do, Study, Act cycle to stagger the implementation of a bundled intervention based on established COPD practice guidelines and published literature on successful care transition interventions. Individual components were prioritized for roll-out based on expected impact and ease of implementation: 1) COPD trained respiratory therapists serving as a transition coach/navigator, bridging inpatient and outpatient settings and responsible for assessing patients’ medical, psycho-social, and palliative care needs; 2) completion of a pulmonary consult during the hospitalization; 3) coupling interactive patient education videos and one-on-one teach backs during the hospitalization with continued reinforcement in the outpatient clinic; 4) arranging a follow up visit with the same inpatient pulmonologist within 7-14 days of discharge; and 5) enrolling patients into pulmonary rehabilitation.

RESULTS: Facilitators to implementation of the bundle included high level executive and administrative support, physician champions who were actively involved in case finding and troubleshooting, respiratory therapists who practiced at the top of their license, data systems that allowed for real-time identification of patients who were admitted for a COPD exacerbation or pneumonia, and the project team’s vigilance in coordinating with other concurrent efforts within the health system to minimize redundancies and confusion for patients. Having adequate staffing remains a key barrier.

CONCLUSIONS: We identified key facilitators and barriers to implementing a care transition bundle for COPD.

CLINICAL IMPLICATIONS: Successful adaptation and implementation of evidence-based transition care interventions requires sustained alignment of institutional priorities and resources.

DISCLOSURE: The following authors have nothing to disclose: Augusto Cam, Hector Garcia, Rene Patino, Luis Moreta-Sainz, Matthew Devine, Oscar Salazar, Huong Nguyen

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