Center for Respiratory and Sleep Medicine COPD Chronic Disease Management Program Cristina Ashworth, NP Khalil Diab,MD
Center for Respiratory and Sleep Medicine Subgroup of Indiana Internal Medicine Consultants Eleven Pulmonary and Critical Care Physicians Four Pulmonary Nurse Practitioners Large outpatient center Large inpatient population
Outpatient Center Pulmonary Function Test Laboratory Pulmonary Rehabilitation Program Sleep Laboratory DEXA scanning X-ray Machine Development of Infusion Clinic
Inpatient Coverage Management of the Intensive Care Units of all hospitals on the south side of Indianapolis Saint Francis Hospitals and Health Centers Community South Hospitals Management of the two long term acute care facilities on the south side Kindred South Select Hospital
COPD Chronic Disease Management Team Pulmonary & Critical Care Medicine Physicians Khalil Diab, MD Aaron Bruns, MD Pulmonary Nurse Practitioner Cristina Ashworth, NP Office Coordinator Tina Elliot, Assistant Administrator
Goals & Objectives Early diagnosis and identification of COPD patients Decrease the smoking rate in COPD patients Improve the quality of life of the patients Appropriate Medical Therapy Pulmonary Rehabilitation Program Decrease the number of exacerbation of disease Hospitalizations related to that
COPD Population 19240 patients (inpatients and outpatients) 10/1/2009 9/30/2010 Southern suburbs of Indianapolis Some southern parts of Indiana
COPD Population Population Identification 491: chronic bronchitis 492: emphysema 493.2x: COPD with asthma 496: chronic airway obstruction, not elsewhere classified (305.1 or V15.82) and 786: patients with both tobacco dependence and dyspnea 491.21:COPD exacerbation 273.4: Alpha 1 antitrypsin deficiency
Primary Outcome Measures Rate of COPD exacerbations Rate of hospitalizations related to COPD exacerbations
Secondary Outcome Measures Quality of life Change in FEV1 Smoking cessation rate Other Outcomes Rate of alpha 1 antitrypsin deficiency identification Osteopenia and Osteoporosis identification
Improvement Interventions Early identification of COPD patients Early institution of preventative measures Improvement in Quality of Life Early pulmonary rehabilitation enrollment Early institution of appropriate medical therapy Training in correct use of inhalers Early institution of oxygen therapy
Improvement Interventions Decrease the rate of tobacco abuse Aggressive behavioral and pharmacologic interventions Decrease the rate of complications Early identification of osteopenia and osteoposis Early nutritional intervention Aggressive vaccination program Decrease the rate of COPD exacerbations
Measurement of Outcomes Rate of COPD exacerbation Data collection of all hospital admissions related to COPD Instructing patients to record and report symptoms of milder COPD exacerbations at home Quality of Life Measures Saint George s Respiratory Questionnaire Baseline, after pulmonary rehabilitation 6 months, 1 year
Measurement of Outcomes Rate of Lung function decline Pulmonary function tests (6 months to 1 year) 6 minute walk tests (6 months to 1 year) Smoking cessation rate Questions about smoking cessation on each visit Osteoporosis Prevention DEXA scanning Alpha 1 antitrypsin identification Alpha 1 antitrypsin levels on all patients Nutritional Status (BMI)
Challenges Enrollment and compliance with pulmonary rehabilitation programs Success with tobacco cessation Success with influenza vaccinations Alteration of BMI Compliance with precribed medications Compliance with Oxygen Therapy Adequate reporting of COPD exacerbations
Successful Program Primary outcome Significant decrease in rate of COPD exacerbations Significant decrease in hospitalization rate
Successful Program Secondary Outcomes Improvement in quality of life Decrease in the rate of tobacco use Stabilization of disease status FEV1 Weight Increased identification of osteopenia and osteoporosis Increased identification of alpha 1 antitrypsin deficiency
Future Steps Increase the number of patients in our clinic Increase awareness in the community Importance of a protocol program of COPD management Transmitting our data to other primary care clinics in the area Saint Francis Hospitals and Health Services Community South Hospitals
Future Steps Focus on protocol management of other pulmonary diseases Asthma
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