Evaluation of an implementation package to deliver the COPD CARE service

被引:0
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作者
Portillo, Edward [1 ]
Lehmann, Molly [2 ]
Hagen, Timothy [3 ]
Maurer, Martha [1 ]
Kettner, Jordyn [2 ]
Bhardwaj, Sonia [2 ]
Goodrich, David [4 ]
McFarland, M. Shawn [5 ]
Virrueta, Natasha [2 ]
Henderson, Blake [6 ]
Birstler, Jen [7 ]
Chui, Michelle A. [1 ]
机构
[1] Univ Wisconsin Madison, Sch Pharm, Madison, WI 53706 USA
[2] William S Middleton VA Hosp, Dept Vet Affairs, Madison, WI USA
[3] Healthcare Syst Ozarks, Dept Vet Affairs, Fayetteville, AR USA
[4] Ctr Hlth Equ & Promot CHERP, Dept Vet Affairs, Pittsburgh, PA USA
[5] Dept Vet Affairs, Clin Pharm Practice Off, Washington, DC USA
[6] Dept Vet Affairs, Diffus Excellence, Washington, DC USA
[7] Univ Wisconsin Madison, Inst Clin & Translat Res ICTR, Madison, WI USA
关键词
Quality improvement; Pharmacists; Medical education; SCIENCE; FRAMEWORK;
D O I
10.1136/bmjoq-2022-002074
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide and is estimated to be the leading cause of death in the next 15 years. Patients with COPD suffer from persistent chronic cough, sputum production and exacerbations leading to deteriorating lung function, worsening quality of life and loss of independence. While evidence-based interventions exist to improve the well-being of patients with COPD, incorporation of these interventions into routine clinical care is challenging. Chronic Obstructive Pulmonary Disease Coordinated Access to Reduce Exacerbations (COPD CARE) is a team-based, coordinated care transitions service integrating evidence-based interventions for COPD management within the patient care delivery model to reduce readmissions. This evaluation considers the process of scaling the COPD CARE service across medical facilities using an implementation package designed for service expansion. The implementation package was developed at the United States Veterans Health Administration and implemented at two medical centres. Core dissemination and implementation science methods were applied to guide design and delivery of the implementation package.The aims of this evaluation were to (1) evaluate the impact of the implementation package on use of evidence-based interventions for COPD management and (2) explore clinician perceptions of the implementation package. This prospective mixed-methods quality improvement project included two Plan Do Check Act (PDCA) cycles conducted over a 24-month period. Electronic health record data demonstrated significant improvements in the count of evidence-based interventions incorporated into routine clinical care after training completion (p<0.001), offering preliminary effectiveness of the package to improve uptake of best practices for COPD management. Clinician perceptions of the implementation package, measured by questionnaire at multiple time points, demonstrated significant improvements for all scales at the end of the final PDCA cycle. Clinicians described the implementation package as positively impacting clinician confidence, interprofessional collaboration and patient care delivery.
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