FEASIBILITY OF REAL-TIME COMBINED PATIENT AND PROVIDER TEACHING TO IMPROVE GUIDELINE-DIRECTED THERAPY IN COPD EXACERBATION

Abstract

SESSION TITLE: Obstructive Lung Disease Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Despite the availability of COPD guidelines with evidence-based recommendations, care that patients receive varies. We undertook a quality improvement initiative regarding patients admitted with acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Our primary aim was that 80% of patients admitted with AECOPD receive inhaler teaching, be discharged on appropriate long-acting medication, and receive referral for pulmonary rehabilitation. METHODS: Inpatients aged 40 years or older with an ICD-10 diagnosis of COPD exacerbation were identified daily using software between June 19 and November 20, 2019. Patient outcomes were compared to a group of 50 control patients admitted with AECOPD prior to the intervention period. Patients received education from a nurse practitioner and clinical pharmacist. This included an NIH booklet, inhaler training, and discussion of the importance of pulmonary rehabilitation and smoking cessation. Simultaneously, on-demand teaching was performed with the patient's Medicine service. Teaching consisted of a 15-minute education session reviewing the COPD GOLD staging criteria, a review of medications based on stage, and reinforced the importance of pulmonary rehabilitation. Providers were tested before and after the teaching intervention. RESULTS: The intervention provided on-demand education to 71 providers. On the post-test, providers showed improved knowledge on questions regarding COPD staging and exacerbation risk (81% correct vs. 43% on pre-test, P<0.001) and evidence-based treatment (83% correct vs. 28% on pre-test, P<0.001). Forty-four patients screened in to the intervention. The median age was 72 and median pack-years was 40. Median FEV1 was 47% of predicted. The COPD education intervention was received by 75% of screened patients. Ninety percent of patients were discharged on any long-acting inhaler, similar to the group of pre-intervention controls. Pulmonary rehabilitation referrals were made for 50% of patients compared to 6% of pre-intervention controls (P<0.001). Triple therapy was appropriately prescribed in 59% of patients at discharge compared to 50% of pre-intervention controls. Of patients not already on triple therapy, 44% received a “step up” in therapy and were discharged on an additional medication compared to admission. CONCLUSIONS: In an intervention that combined on-demand teaching of providers with patient education, referral for pulmonary rehabilitation increased for patients admitted with AECOPD. Providers demonstrated improved knowledge and confidence regarding AECOPD management. Many patients received an appropriate step up in therapy, and 90% were discharged on a long-acting inhaler. CLINICAL IMPLICATIONS: Our study featured on-demand teaching for providers in addition to patient teaching. This intervention led to improved care for patients after admission for AECOPD, and improved provider knowledge and confidence. DISCLOSURES: No relevant relationships by Lorenzo Bean, source=Web Response no disclosure on file for Jamuna Krishnan; No relevant relationships by Jessica Snead, source=Web Response No relevant relationships by Mark Sonnick, source=Web Response No relevant relationships by Maria Spinelli, source=Web Response No relevant relationships by Meredith Turetz, source=Web Response No relevant relationships by Maya Viavant, source=Web Response No relevant relationships by Xian Wu, source=Web Response