University of Wisconsin-Madison, School of Pharmacy, Madison, Wisconsin, USA
Department of Veterans Affairs, William S. Middleton VA Hospital, Madison, Wisconsin, USA.
BMJ Open Qual. 2023 Feb;12(1). doi: 10.1136/bmjoq-2022-002074.
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.
慢性阻塞性肺疾病（COPD）是全球第三大致死原因，预计在未来 15 年内将成为首要致死原因。COPD 患者会出现持续的慢性咳嗽、咳痰和病情恶化，导致肺功能下降、生活质量恶化和丧失独立性。虽然存在改善 COPD 患者健康状况的循证干预措施，但将这些干预措施纳入常规临床护理具有挑战性。慢性阻塞性肺疾病协调获取以减少恶化（COPD CARE）是一种基于团队的协调护理过渡服务，将 COPD 管理的循证干预措施整合到患者护理提供模式中，以减少再入院。本评估考虑使用专为服务扩展设计的实施包在医疗设施中扩展 COPD CARE 服务的过程。该实施包在美国退伍军人健康管理局开发，并在两个医疗中心实施。核心传播和实施科学方法被应用于指导实施包的设计和交付。本评估的目的是：(1) 评估实施包对 COPD 管理中循证干预措施的使用的影响；(2) 探索临床医生对实施包的看法。这是一项前瞻性的混合方法质量改进项目，包括在 24 个月的时间内进行两个计划-执行-检查-行动（PDCA）循环。电子健康记录数据表明，培训完成后，常规临床护理中纳入循证干预措施的数量显著增加（p<0.001），这初步证明了该实施包能够提高 COPD 管理最佳实践的采用率。通过多次问卷调查测量的临床医生对实施包的看法表明，在最后一个 PDCA 循环结束时，所有量表都有显著改善。临床医生描述实施包对临床医生的信心、跨专业合作和患者护理的提供产生了积极影响。
