TMF Health Quality Institute Highlights Benefit of COPD Rescue Pack in Suppressing Exacerbations

As part of its Quality Improvement Snapshots series, TMF Health Quality Institute issued 4 healthcare quality improvement efforts, highlighting the use of a rescue pack for patients with chronic obstructive pulmonary disease (COPD) as an impactful strategy in managing COPD-related exacerbations.

Posted in the snapshot titled, “Improving Outcomes for Patients with Chronic Obstructive Pulmonary Disorder (COPD): Use of the COPD Rescue Pack,” researchers from the TMF Quality Innovation Network Quality Improvement Organization (QIN-QIO) detailed the implementation of a Special Innovation Project (SIP) to empower patients in using a COPD rescue pack when experiencing a COPD exacerbation. “The aim of this project was to reduce COPD emergency department (ED) use and subsequent inpatient admissions, while empowering patients to manage their condition by using a COPD rescue pack,” said the researchers.

The COPD rescue pack worked as a 2-year SIP to provide a standardized approach to managing COPD and offered the ability to implement best practice self-management interventions for care teams that enhance COPD management through empowering both patients and providers. Early indication of COPD was promoted through a team-based workflow that systematically flagged patients who warranted intervention. These patients were then provided with 1-on-1 support from a clinical guidance nurse, as well as, further support:

• The COPD rescue pack was provided, which included a patient education packet, prescriptions identified by the care team for antibiotics and steroids, a medical information card, the American Lung Association Classification List, a personalized action plan, and clinical guidance and the nurse’s contact information from the care team

Outcomes from the intervention program were derived from Medicare fee-for-service claims for beneficiaries with COPD from 189 providers located in Arkansas, Missouri, and Oklahoma. Four webinars were used to promote sharing between care teams to identify best practices, successes, challenges, and barriers, with the TMF QIN-QIO staff holding meetings with providers and care teams to promote technical assistance and support.

The intervention program was shown to exceed the initial goal of reducing both hospital admissions and ED visits for acute COPD exacerbations by 10%, per 1000 beneficiaries among participating practice patients. Of the 656 patients prescribed the rescue pack and refills, 43.2% of patients (n=284) reported use of the COPD rescue pack over the 2-year intervention period. The use of the COPD rescue pack was attributed to avoiding ED visits and subsequent hospitalization for 47% of users.

Among 134 (47.2%) of the 284 reported users, a preferred use of the ED instead of the COPD rescue pack was stated.

“The innovative intervention of empowering patient self-management through use of a COPD rescue pack when experiencing a COPD exacerbation was key to impacting the COPD burden in the tristate area of Arkansas, Missouri and Oklahoma,” said the study authors. Researchers noted that 2 lessons were learned from the SIP to move the COPD project forward and engage physicians, which were identifying chronic care managers as key personnel and drivers and delineating a physician clinic champion. Researchers additionally provided 4 lessons learned from the protocol implementation.

• Providing group kickoff calls to introduce the project and materials
• Having practices host group COPD education classes to improve efficiency
• Providing premade rescue packs to save provider time
• Identifying additional TMF QIN-QIO staff to aid with kickoff meetings to ameliorate the effects of internal staff turnover