Abstract
BackgroundChronic obstructive pulmonary disease (COPD) has substantial economic and human costs; it is expected to be the third leading cause of death worldwide by 2030. To minimize these costs high quality guidelines have been developed. However, guidelines alone rarely result in meaningful change. One method of integrating guidelines into practice is the use of clinical pathways (CPWs). CPWs bring available evidence to a range of healthcare professionals by detailing the essential steps in care and adapting guidelines to the local context.Methods/designWe are working with local stakeholders to develop CPWs for COPD with the aims of improving care while reducing utilization. The CPWs will employ several steps including: standardizing diagnostic training, unifying components of chronic disease care, coordinating education and reconditioning programs, and ensuring care uses best practices. Further, we have worked to identify evidence-informed implementation strategies which will be tailored to the local context.We will conduct a three-year research project using an interrupted time series (ITS) design in the form of a multiple baseline approach with control groups. The CPW will be implemented in two health regions (experimental groups) and two health regions will act as controls (control groups). The experimental and control groups will each contain an urban and rural health region. Primary outcomes for the study will be quality of care operationalized using hospital readmission rates and emergency department (ED) presentation rates. Secondary outcomes will be healthcare utilization and guideline adherence, operationalized using hospital admission rates, hospital length of stay and general practitioner (GP) visits. Results will be analyzed using segmented regression analysis.DiscussionFunding has been procured from multiple stakeholders. The project has been deemed exempt from ethics review as it is a quality improvement project. Intervention implementation is expected to begin in summer of 2017.This project is expected to improve quality of care and reduce healthcare utilization. In addition it will provide evidence on the effects of CPWs in both urban and rural settings. If the CPWs are found effective we will work with all stakeholders to implement similar CPWs in surrounding health regions.Trial registrationClinicaltrials.gov (NCT03075709). Registered 8 March 2017.
Highlights
Chronic obstructive pulmonary disease (COPD) has substantial economic and human costs; it is expected to be the third leading cause of death worldwide by 2030
If the Clinical Pathway (CPW) are found effective we will work with all stakeholders to implement similar CPWs in surrounding health regions
Funding for the research has been awarded by the Lung Health Institute of Canada, the Saskatchewan Ministry of Health and through private industry (Novartis)
Summary
Chronic obstructive pulmonary disease (COPD) has substantial economic and human costs; it is expected to be the third leading cause of death worldwide by 2030 To minimize these costs high quality guidelines have been developed. Best practices have been developed to minimize this burden [1,2,3,4], implementation of these practices is generally fragmented [3] In response to this fact, this protocol outlines the process of improving quality of care in two Saskatchewan health regions through the implementation of locally tailored clinical pathways (CPWs) and the subsequent evaluation of these CPWs. Prevalence COPD is most often caused by smoking tobacco [5], but is associated with air pollution [5] and occupational exposures to dusts and chemicals [5]. The province of Saskatchewan has a prevalence similar to the national self-reported rate with an age standardized estimate of 4.3% [8]
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