The Inspired COPD Outreach Program: Outcomes and Efficiencies

Abstract

PURPOSE: Across Canada COPD is the primary cause of hospital admission. Risk of readmission is high. Models of care, by focusing on acute episodes, are failing with significant costs to patients, families, and systems. INSPIRED is a new evidence-based community outreach program introduced to address gaps in care across transitions for those with advanced COPD. INSPIRED over 4 visits provides holistic, needs-based, hospital-to-home services for patients and family caregivers living in Halifax regional municipality (disease self-management education, optimization of pharmacological/non-pharmacological treatments, <> for management of acute exacerbations/dyspnea crises, psychosocial-spiritual support, and engagement of patients/family caregivers in advance care planning (ACP). METHODS: We used a mixed-methods approach to evaluate early program outcomes (in first -30 - 40 patients). Within a week of hospital discharge (Pre-INSPIRED), and after program completion, patients reported health-related quality of life (chronic respiratory questionnaire, CRQ), anxiety/depression (Hospital Anxiety and Depression Scale, HADS), hope (Herth Hope Index) and confidence in self management (Care Transitions Measure, CTM). Using hospital databases and chart reviews, we tracked patients' COPD-related use of acute care services (ER visits, hospital admissions, length of stay (LOS) from one year pre- program enrollment to 12 months following enrollment. RESULTS: To date (March 2013), 150 patients have been enrolled. For patients with complete data 6 months before and after INSPIRED (n=89, excluding non-survivors), ER visits, admissions and LOS were all down by -65% with cost savings of -$750,000. When this assessment was extended to 12 months (n=50), proportionate reduction in facility use was similar. Care Transitions Measure (n=27, median (range) improved from 71 (25-96) to 83 (69-100), p <0.0001. CRQ, HADS and Herth Hope were unchanged. CONCLUSIONS: Our novel evidence based outreach program improves self-efficacy and reduces reliance on facility based emergency care with considerable 'cost savings'.