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.
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.
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.
Learn more about this project »