Spreading ‘INSPIRED’ Approaches to COPD Care

The Challenge

Chronic obstructive pulmonary disease (COPD) is a common, progressive, incurable, but treatable lung condition with uncomfortable breathing as the predominant symptom. COPD is soon to be the third leading cause of death worldwide and already a primary cause of emergency department (ED) and hospital visits in Canada. A nationwide Canadian Lung Association report card on COPD care gave most Canadian provinces poor or failing grades.

A typical scenario for a person living with moderate to severe COPD involves arriving at the ED in crisis, severely short of breath – called an ‘acute exacerbation of COPD’ or AECOPD – prompting hospitalization and a lengthy hospital stay. When home again, without early follow-up and with no plan for the next AECOPD, the patient often goes ‘off the radar’ before the cycle repeats itself.

This state of affairs plays out at hospitals across the country, falling short in addressing the medical, psychosocial and spiritual care needs of patients and their families in a patient-centered, evidence-informed and cost-effective way. In addition to the anxiety this situation causes patients and families, it significantly strains healthcare resources. In Canada, COPD exacerbations account for more than $750-million a year in hospital-based costs – an estimate that does not include the costs of routine care.

In Halifax, Nova Scotia, the same scenario was playing out. At the Queen Elizabeth II Health Sciences Centre (QEII HSC) at Capital Health, COPD is second only to chest pain among medical reasons for ED visits and patients with AECOPD accounted for approximately 300 admissions a year with an average length of stay of 10 days, costing $3-million annually in inpatient bed costs.

The Improvement

A team at Capital Health, led by Respirologist (now CFHI Clinical Improvement Advisor) Dr. Graeme Rocker, Respiratory Therapist Ms. Joanne Michaud-Young and Spiritual Care and Advance Care Planning Facilitator Dr. Catherine Simpson, developed and implemented the INSPIRED COPD Outreach ProgramTM in 2010. ‘INSPIRED’ (which stands for “Implementing a Novel and Supportive Program of Individualized Care for patients and families living with REspiratory Disease”) takes a proactive approach to caring for patients living with advanced COPD and their families. By responding to the underlying and unmet needs of patients and families living with moderate to severe COPD, INSPIRED delivers more holistic and individualized patient care, supports family caregivers and reduces reliance on hospital-based care. It zeroes in on the gaps in care that underlie the COPD (and chronic disease) care challenge. It offers hospital-to-home outreach – including home visits and access to a telephone ‘hotline’ – in a way that is dignified and well-coordinated, providing patients and their families with self-management education, confidence and an action plan to guide treatment choices at home, psychosocial and spiritual care support and access to advance care planning.

INSPIRED Approaches to COPD

Members of the INSPIRED COPD Outreach ProgramTM team at the Queen Elizabeth II Health Sciences Centre in Halifax
Left to right: Ms. Holly Kennedy, Respiratory Therapist; Ms. Catherine Simpson (retired), Spiritual Care and Advance Care Planning Facilitator; Dr. Graeme Rocker, Medical Director; Ms. Jillian Demmons, Coordinator & Evaluator; and Ms. Denise Nauss, Family Caregiver. (Team members not shown include Respiratory Therapists: Ms. Wendy Conrad, Mr. John Cushing, Ms. Andrea Dale and Ms. Jane Donovan; Ms. Darcy Gillis, Spiritual Care Practitioner; Ms. Heidi Blois, Administrative Assistant; and Ms. Joanne Michaud-Young, INSPIRED co-founder)

The Impact

Six months after their enrolment in the program at the QEII HSC, INSPIRED patient and family experiences of care improved and patients’ ED visits fell by 60 percent, hospitalizations fell by 63 percent and days in hospital fell by 62 percent by comparison with their previous experience. The reduction in hospitalizations translates into an estimated $977,000 – more than three times the annual operating costs of INSPIRED.

These reductions continued into the 12-month patient follow-up, resulting in 52 percent fewer ED visits, 55 percent fewer hospital admissions and 61 percent fewer hospital days. Interviews post-INSPIRED showed patients felt more confident in managing their symptoms and willing to discuss goals of care, including advance care planning. The quality of care transitions (from the hospital to home) was also significantly improved. These and other results were published in October 2014 in the peer-reviewed journal, Clinical and Investigative Medicine by Dr. Rocker and CFHI’s Senior Director, Collaboration for Innovation and Improvement. Ms. Jennifer Verma. In spring 2014, INSPIRED received an Accreditation Canada 'Leading Practice' designation as a noteworthy example of high-quality leadership and service delivery in COPD care.

“I used to feel so alone with my illness. Now people check on me and I know there’s someone I can call if I’m having a problem. I would feel so isolated, frustrated and apprehensive without this support.”

—INSPIRED patient

“There were times when panic was setting in... It was a tremendous relief to know that I wasn’t alone and that there was someone who cared that I could turn to... You handled Mum with such dignity and respect that I can never thank you enough!”

—INSPIRED family caregiver

The Spread

The INSPIRED COPD Outreach ProgramTM is a program worth spreading. As part of the Atlantic Healthcare Collaboration for Innovation and Improvement in Chronic Disease, in 2012, CFHI connected Dr. Rocker and Ms. Young as coaches with an improvement team, led by Ms. Valerie Pritchett, Director of Cardiopulmonary Services at Central Health in central Newfoundland and Labrador (NL), where COPD is the leading cause of ED and hospital visits and associated with the longest hospitals stays of all chronic conditions. Dr. Rocker and Ms. Young helped the team to identify and respond to the most urgent patient care needs. In fall 2014, the Central Health team opened its doors to a new adult ambulatory Respiratory Care Centre at the James Paton Memorial Regional Health Centre in Gander, NL under the care provision of Internist, Dr. Ethelbert Ugwoke. The central NL team is also creating their own version of the INSPIRED COPD Outreach Program that incorporates telehealth.

Newfoundland and Labrador Central Health COPD Improvement team

Newfoundland and Labrador Central Health COPD Improvement team
Back row: Left to right: Dr. Ethelbert Ugwoke, Internist; Ms. Valerie Pritchett, Director of Cardiopulmonary Services and team lead; Ms. Rosemarie Goodyear, Chief Executive Officer, Central Health; Ms. Natalie Reardon, Manager of Program Planning and Evaluation; Front row: Ms. Jill Collins, Clinical Lead Respiratory Therapy, James Paton Memorial Health Centre; Ms. Sherry Freake, Chief Operating Officer, Gander and Area, and Ms. Bev White, Director of Population and Public Health.

INSPIRED Approaches to COPD Care: Improving Care and Creating Value is one of two collaboratives in CFHI’s Spreading Healthcare Innovations Initiative. These collaboratives bring together healthcare delivery organizations to make sustainable changes that improve patient and family experience and outcomes, better coordinate approaches to complex health needs and maximize healthcare efficiencies. CFHI, with support from Boehringer Ingelheim (Canada) Ltd. (BICL), provided funding, coaching, educational materials and tools, and other support to 19 teams from all 10 provinces to transform care for people living with COPD and support their caregivers.


Launch of the INSPIRED Approaches to COPD: Improving Care and Creating Value Collaborative
Left to right: Mr. Richard Mole, President and Chief Executive Officer of Boehringer Ingelheim (Canada) Ltd. (BICL); Mr. Tom Closson, Vice-Chair of CFHI’s Board of Directors; Mr. David Smith, INSPIRED patient; Dr. Graeme Rocker, Medical Director, INSPIRED COPD Outreach ProgramTM; Ms. Jennifer Verma, Senior Director of Collaboration for Innovation and Improvement, CFHI; Mr. Ernie Hampel, Executive Director, Market Access of BICL.

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