Integration of the patient-centered medical home to deliver a care bundle for chronic obstructive pulmonary disease management

Abstract

BackgroundChronic obstructive pulmonary disease (COPD) is the third leading cause of death globally and is projected to be the leading global cause of death in the next 15 years. Although best practices exist to improve outcomes for patients with COPD, delivering these interventions at scale remains a challenge. ObjectivesThis evaluation explores the impact of a COPD primary care bundle titled Chronic Obstructive Pulmonary Disease Coordinated Access to Reduce Exacerbations (COPD CARE) on patient outcomes. Primary objectives are (1) to determine 30-day readmission rates after discharge from the hospital and emergency department, (2) to evaluate patient access to primary care services after discharge, and (3) to measure incorporation of COPD best practices into routine clinical care. Practice descriptionThe current evaluation explores the impact of the COPD CARE service, an interprofessional primary care model that leverages pharmacists within the patient-centered medical home to deliver COPD management best practices. Pharmacists providing COPD CARE serve in a prescribing role to optimize medication therapy, order spirometry, place critical patient referrals, and coordinate patient follow-up. Practice innovationPharmacists delivering the COPD CARE service independently manage COPD as prescribers and coordinate provision of care with the primary care team. Evaluation methodsThis retrospective evaluation of the COPD CARE service occurred at 2 medical centers and 5 associated outpatient clinics within the Department of Veterans Affairs. ResultsA total of 118 patients completed the COPD CARE service, with no statistically significant differences in patient age, gender, race, tobacco use, or Global Initiative for Chronic Obstructive Lung Disease stage between the COPD CARE and comparator group. Receipt of the COPD CARE service was associated with a 15% reduction in all-cause 30-day readmissions compared with TAU (COPD CARE, 14%; treatment as usual [TAU], 29%; P < 0.05). A total of 92% of patients enrolled in COPD CARE received primary care follow-up within 30 days of discharge compared with 49% in the comparator group (P < 0.001). ConclusionCOPD CARE participation resulted in greater access to health care, increased receipt of COPD management best practices, and readmission reduction.