Coordinated Regionwide Care Management Intervention for Patient with Chronic Obstructive Pulmonary Disease at Risk of Acute Exacerbation Reduces Hospital Days



 

Richard Mularski, MD, MSHS, MCR; Sanja Uskokovic, MS, PMP;
David M Mosen, PhD; Bryan L Skalberg, MS;
Achikam Haim, PhD; Marianne C Turley, PhD;
Nancy L Lee, RPh; Wui-Leong Koh, MD

https://doi.org/10.7812/TPP/19-039-15

Abstracts from the Kaiser Permanente 2019 National Quality Conference

From Northwest

Background: Chronic obstructive pulmonary disease (COPD) affects 12 million to 29 million individuals resulting in 800,000 yearly hospitalizations in the US. Implementation deficits for COPD care results in excess acute exacerbations (AEs), lowered quality of life, reduced functional status, and compromised survival. We developed and tested a targeted intervention across the Northwest Region to identify patients at high risk, provide guideline-recommended proactive care, and evaluate process and outcome metrics for this population.
Methods: We identified an at-risk COPD population in 2 phases for implementation defined by (phase 1) age older than 65 years by International Classification of Diseases-10 visits and 2 or more AEs in the prior year with systemic steroid dispensing or (phase 2) age older than 40 years with any COPD AE hospitalizations in the previous year. Multiple coordinated care management teams completed an action plan (standardized symptoms linked to actions such as start medications) with patients, facilitated influenza/pneumococcus vaccines, and provided rescue medications. Process measures assessed care delivery components; outcome metrics (included AEs, utilization, and death) were compared with historical controls and completers (received all planned interventions/medications) were compared with noncompleters.
Results: We identified 149 patients in phase 1 and 264 in phase 2; respective historical cohorts had 118 and 149 patients. Action plans were delivered in 55% of outreached patients; vaccine rates improved from < 50% to 65% (p < 0.01); and rescue medication orders improved from < 1% to 20% (p < 0.0001). Nonsignificant trends were seen in hospital admissions (26% postimplementation vs 31% preimplementation) and 30-day readmission (18% vs 35%). Hospital days were reduced in completers (0.94 ± 2.51 days) vs those who did not receive all components (1.90 ± 5.58 days, p < 0.05). Similar trends were seen in other measures of utilization. Additionally, in the completer group, mortality trended down from 6.0% to 1.3% (not significant), as did overall AEs from 25.0% to 20.5% (not significant) compared with noncompleters.
Discussion: Our analysis showed that a proactive program coordinating care management for at-risk COPD patients had a favorable impact on care delivery and utilization. We completed a second year of the intervention (evaluation pending summer 2019) and are preparing for regionwide spread of these improvements in care delivery with all primary care providers to further attempt to reduce AEs and hospitalizations for patients with COPD. Using a population-based strategy supported by our Region’s learning health system work, we identify individuals for preventative services. Multiple coordinated care management teams are trained; using electronic medical record-based strategies clinicians contact patients, compete an action plan, facilitate vaccine completion, and provide rescue medications to be used at early signs of AE.

Abstracts from the Kaiser Permanente 2019 National Quality Conference


 

Promising Methods for Improving Quality Through the Faster Spread of Best Practices

Abstracts2019TableThese abstracts reflect the critical importance of a forum for presenting promising quality efforts. Meetings focused on quality improvement, such as those hosted by the Institute for Healthcare Improvement, the American Medical Group Association, and many other organizations, represent a relatively small percentage of all scientific medical meetings. The publication of abstracts from a dedicated quality event such as the Kaiser Permanente National Quality Conference allows those inside and outside of Kaiser Permanente to learn about new and potentially unfamiliar practices that could improve care.

BEHAVIORAL HEALTH

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Lessons from Implementation of Behavioral Health Integration in Kaiser Permanente Washington
Rebecca Parrish, MSW; Ryan M Caldeiro, MD; Amy Lee, MPH

WELL BEING

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Malama Ola—Taking Care of Your Well-Being
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Increasing Team Safety and Response to the Threatening Member
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CARE MANAGEMENT

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Measuring Diagnostic Error: A Review of Patient Complaints
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No Place Like Home: Surgical Home Recovery
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Mid-Atlantic States Chronic Heart Failure Program
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Patient-Centered Management for Chronic Disease—A Model Applied to Parkinson Disease Care in Southern California
Jason Cheves, MSBA; Steve Cedrone, MBA; Todd Sachs, MD; Kathy Kigerl, RN, MN

Coordinated Regionwide Care Management Intervention for Patient with Chronic Obstructive Pulmonary Disease at Risk of Acute Exacerbation Reduces Hospital Days
Richard Mularski, MD, MSHS, MCR; Sanja Uskokovic, MS, PMP; David M Mosen, PhD; Bryan L Skalberg, MS; Achikam Haim, PhD; Marianne C Turley, PhD; Nancy L Lee, RPh; Wui-Leong Koh, MD

Decreasing Sleepless Nights for Patients and Practitioners by Fast Tracking Patients with Diagnostic Images Highly Suspicious for Cancer
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Combining Minimally Invasive Thoracic Surgery Techniques and a Multidisciplinary Care Model Leads to Superior Outcomes
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Patient-Centered Redesign of Total Joint Replacement Care: Achieving the Quadruple Aim
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HIV/AIDS: A 30-Year History of Care Delivery
Patricia L Philbin, RN; Karen Lewis Smith, MHA; Susan McDonald, RN, MSN; Kathy Brown MD, FACP, AAHIVS; Dan Kent, PharmD

Enhancing Dispositions from the Emergency Department—the Northern California Journey to Care for Increasingly Complex Populations
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Mid-Atlantic States Hospital Patient Day Rate Reduction
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Preventing “Silent Droppers”: Standardizing Interventions to Prevent Lung Function Decline in Patients with Cystic Fibrosis
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EQUITY

Igniting an Inclusive Movement—Utilizing ILEaD (Inclusively Leading Through Equity and Diversity)
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Addressing Disparities in Health with Motivational Interviewing
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The Community Action Poverty Simulation
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MEDICATION MANAGEMENT

Reducing Opiate Use in Children and Teens: A Strategic Approach to a National Challenge
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Impact of Medication Reconciliation Programs on Reducing Readmission Rate and Enhancing Medication Safety During Transitions of Care
Alfonso Becerra, PharmD; Donald Yee, RPh; Karen Cham, PharmD; Sheireen Huang, PharmD; Shubhi Nagrani, PharmD; Adenola Akilo, PharmD; Karina Briones, PharmD; Kelvin Chan, PharmD; Carolyn Woo, PharmD; Chad Friday, RPh

PATIENT ENGAGEMENT

Human-Centered Design at Kaiser Permanente: A Creative Approach to Problem Solving
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Meeting Members’ Wishes in the Last Year of Life: A Journey Toward Concordance in Southern California
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Using Insights from End-of-Life Care Survey to Drive Improvement of Care at the End of Life
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Reducing Preventive Flips to Diagnostic—A Holistic Approach to Improving the Financial Experience for Members
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TOTAL HEALTH

How Healthy Is My Community—Designing a Measurement System for Leaders and Implementers
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If You Want to Know How Mrs Smith is Doing, Ask Her! KP’s Improved Medicare Total Health/Social Risk Assessment
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Bridging Barriers to Care Access and Delivery: The Automation of Nonemergent Transportation in Kaiser Permanente Mid-Atlantic States
Kyle M Heidenberger; Rachel E Hill; Melissa Baldwin, MS, MBA; Jason C McCarthy, PharmD, MBA

Addressing Social Needs: Organizational Learnings and Connecting with Our Communities
Sarita A Mohanty, MD, MPH, MBA; John F Steiner, MD, MPH; Nicole Friedman, MS; Briar Ertz-Berger, MD, MPH

TEAMS

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In-Basket Management: Empowering Nurses to be First Responders for Patient Messages, Providing The Right Care at The Right Time
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The Implementation of High-Reliability Organization Model for the Environmental Services Department at Santa Clara Medical Center
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Building A Virtual Nursing Team: Implementation of the Advance Alert Monitor
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Improving Quality and Safety Together: Reducing Primary Cesareans Perinatal Core Measure Collaborative
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TECHNOLOGY

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Using Human-Centered Design to Expand Telehealth Into the Hospital and Continuum
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Home Health Virtual Complexivist Physician Program: Leveraging Increased Scope of Care at a Crucial Time
Alicia Ahn, MD; Sandra Barton, MD; Binitha X Surendran, MBA, MS

Improving Patient Safety Via Information Transparency and Performance-Improvement Infrastructure
Asia Plahar, MS, RN; Kathy Ricossa, MS, RN

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