Sonnick Mark A, Viavant Maya, Turetz Meredith L, Bean Lorenzo D, Jannat-Khah Deanna, Krishnan Jamuna K, Snead Jessica, Spinelli Maria, Wu Xian, Lee Jennifer I
Weill Department of Medicine.
Division of Pulmonary and Critical Care Medicine, and.
ATS Sch. 2021 Dec 17;3(1):87-98. doi: 10.34197/ats-scholar.2021-0077OC. eCollection 2022 Mar.
It is not known whether an intervention using real-time provider teaching in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) improves provider knowledge and/or patient outcomes.
To pilot the combination of a novel, real-time provider teaching intervention delivered by subspecialists to Internal Medicine trainees with a traditional patient education and medication reconciliation (PEMR) intervention and to assess the impact of these interventions on provider knowledge regarding COPD and patient care.
This was a single-center, nonrandomized, quality-improvement study. Patients admitted with AECOPD were prospectively identified between June 19 and November 20, 2019. Patients with asthma, lung cancer, or interstitial lung disease were excluded. The primary care team received a novel intervention featuring in-person, real-time teaching, covering Global Initiative on Chronic Obstructive Lung Disease COPD groups and management, including pulmonary rehabilitation referral. Providers completed a knowledge assessment before and after their real-time teaching session. Provider knowledge scores before and after teaching were compared using McNemar's test. Patients received a traditional PEMR intervention from a nurse practitioner and/or clinical pharmacist. A retrospective chart review was conducted for 50 historical control patients admitted with AECOPD to obtain preintervention rates of discharge on long-acting bronchodilators and referral to pulmonary rehabilitation. The proportions of patients discharged on long-acting bronchodilators and referred to pulmonary rehabilitation in the intervention group were compared with the preintervention historical control patients using chi-square testing.
Seventy-one providers caring for patients with AECOPD received real-time teaching. Postintervention, there was significant improvement in knowledge scores pertaining to Global Initiative on Chronic Obstructive Lung Disease groups and exacerbation risk (81% correct vs. 43% on pretest; < 0.001) and guideline-directed treatment (83% correct vs. 28% on pretest; < 0.001). Out of 44 eligible patients, 75% ( = 33 patients) received the PEMR intervention. Ninety percent of patients ( = 40 patients) were discharged on any long-acting inhaler, similar to the group of preintervention control subjects. Pulmonary rehabilitation referrals were made for 50% of patients ( = 22 patients) compared with 6% of preintervention control subjects ( = 3 patients; < 0.001).
In this single-center quality-improvement study, the combination of a novel, real-time provider teaching intervention and a traditional PEMR intervention improved provider knowledge and was associated with increased referrals to pulmonary rehabilitation.
在慢性阻塞性肺疾病急性加重期（AECOPD）中，采用实时医护人员教学的干预措施是否能提高医护人员的知识水平和/或改善患者预后尚不清楚。
试行由专科医生对内科住院医师进行的新型实时医护人员教学干预与传统患者教育及用药核对（PEMR）干预相结合的方法，并评估这些干预措施对医护人员关于慢性阻塞性肺疾病的知识及患者护理的影响。
这是一项单中心、非随机的质量改进研究。前瞻性地确定了2019年6月19日至11月20日期间因AECOPD入院的患者。排除患有哮喘、肺癌或间质性肺疾病的患者。初级保健团队接受了一项新型干预措施，包括面对面实时教学，内容涵盖慢性阻塞性肺疾病全球倡议组织（GOLD）分组及管理，包括肺康复转诊。医护人员在实时教学课程前后完成了知识评估。使用McNemar检验比较教学前后医护人员的知识得分。患者接受了执业护士和/或临床药剂师进行的传统PEMR干预。对50例因AECOPD入院的历史对照患者进行回顾性病历审查，以获取长效支气管扩张剂出院前使用率及肺康复转诊率。使用卡方检验将干预组中使用长效支气管扩张剂出院及转诊至肺康复的患者比例与干预前历史对照患者进行比较。
71名护理AECOPD患者的医护人员接受了实时教学。干预后，与慢性阻塞性肺疾病全球倡议组织分组及急性加重风险相关的知识得分有显著提高（测试后正确率81%，测试前为43%；P<0.001），以及指南指导治疗方面（测试后正确率83%，测试前为28%；P<0.001）。在44例符合条件的患者中，75%（n=33例患者）接受了PEMR干预。90%的患者（n=40例患者）使用任何长效吸入器出院，与干预前对照组相似。50%的患者（n=22例患者）被转诊至肺康复，而干预前对照组为6%（n=3例患者；P<0.001）。
在这项单中心质量改进研究中，新型实时医护人员教学干预与传统PEMR干预相结合提高了医护人员的知识水平，并与肺康复转诊增加相关。
