A Systems Approach to Chronic Obstructive Pulmonary Disease (COPD) Management in Vancouver and the Lower Mainland (LM): The COPD Lower Mainland Innovation and Integration Fund (LMIIF) Project

Abstract

PURPOSE: Among the major chronic diseases COPD has the highest hospital admission rate in Canada. Significant variations in practice have been documented in the LM, and spirometry is significantly underutilized. This project was designed to improve and streamline COPD management across the LM. METHODS: Using Canadian Thoracic Society and Global Initiative for Obstructive Lung Disease Guidelines, a standard admission pre-printed order set (PPO) was developed for use across 20 sites. A clinical pathway for acute COPD exacerbations was developed to guide inhospital patient management. A COPD discharge plan was created to help transition patients from acute to community for follow up. Evidence based best practice standards are maintained in these documents with flexibility for site specific resources and policies. A universal spirometry requisition was created to simplify family physician (FP) referral for correct screening and diagnosis. In addition, a universal COPD management services form was created to simplify referral to support services (Pulmonary Rehabilitation, self-management services, COPD Clinics). Education was provided to FPs on the role of spirometry and management of COPD, including patient education and the benefits of rehabilitation. RESULTS: During the implementation phase, an additional 50% spirometries were performed. Some sites exceeded 50% above their baseline target. Wait times for spirometry testing decreased to under 2 weeks in 8 of 12 sites and 3 additional walk-in clinics were opened. A PPO, clinical pathway, and discharge plan were created and are currently being approved across the LM. CONCLUSION: This project has shown that a systems approach to COPD management can be implemented across a large number of hospitals. Preliminary results show a significant improvement in access to spirometry. CLINICAL IMPLICATIONS: COPD management varies between hospitals. A systems approach to COPD management can be achieved consistently across multiple sites.