Amy W. Shaheen, MD MSc

Shane Hemphill, MD

Michelle Walsh, RN

Stephanie Edwards, MHA

Marci Olsen, PA-C

Candice Hunt, MHA

Spreading Improved Care of Patients with Chronic Obstructive Pulmonary Disease (COPD)

Patient Experience

65 year old male from rural county

History of Lung Cancer Daily SOB and recent

hospitalization Inhaler technique poor Nurse does teach back with

inhaler But the patient has ran out of

the inhaler and cannot afford to purchase a new one at the cost of $400

Diagnostic Spirometry

From 25% to 60%

Rescue Inhalers

From 60% to 80%

Symptom Assessment

From 0% to 20%

Inhaler Education

From 0% to 12%

Improve care of patients with COPD by improving the indicatorsof high quality care

Sept 2017 to Sept 2018

What were we trying to accomplish?

Why is this important?

Practice• Cary, NC

• 3 Providers, 170 patients in COPD registry, 50% Medicare, 6 support staff

Local• 20-30% of UNC COPD patients result in readmission

State• 7% of NC residents have COPD

National

• 20% of COPD Pts result in readmission

• Top 5 hospital admission

• Annual cost - $49 Billion

What Changes Did We Make?

Visit Based Reminders

Training

Data

Dashboards

Standard work

Needs assessment

Process Map of Inhaler Education STEP 1

MA Identify

need for

inhaler

education

using BPA

Find

appropriate

demos to

teach with if

patient has

not brought

inhalers

Notify

physician

that

inhaler

education

is needed

Provide

inhaler

education

Document

on paper

MD Complete

visit, push

bell for MA

when done

25% of patientsmisdiagnosed!

25% of patientsmisdiagnosed!

Sustainment

•MMRC Symptom Assessment

•Uncontrolled Step Therapy

• Spirometry

•Rescue Inhaler

• Inhaler Education

Best Practice Advisory (BPAs)

•MMRC Symptom Assessment 40%

•COPD Pts with MMRC > or = 2 with appropriate treatment (TEST metric)

FY 19 PCIC Measures•Action plans

•Standardize Acute Management

• Improved outcomes

Acute management and centralized

services

Spread and Next Steps

Toolkit and quality assurance

Manuscript and centralized pharmacy assistance

Build Physician Leadership CapacityPCIC OPS and UNC HCS

Develop

Disseminate