2.50
Hdl Handle:
http://hdl.handle.net/10755/338338
Category:
Full-text
Type:
Presentation
Title:
The COPD Journey: Care Management Across the Continuum
Author(s):
McGee, Allison; Ricks, Nichole
Lead Author STTI Affiliation:
Pi Nu
Author Details:
Allison McGee, RN, BSN, MSN, allison.mcgee@wellstar.org; Nichole Ricks, RN, BSN, MSN
Abstract:
Session presented on Friday, September 26, 2014: Purpose: The purpose of the care management program is to provide patients and family members with a safe and smooth transition from the acute care environment to the outpatient setting. The significance of the care management program is to improve a patient's quality of life while living with chronic obstructive pulmonary disease (COPD). The goals include, "BREATHING EASIER" education to empower patients to take control of their disease process, referral to appropriate outpatient programs, and reducing hospital readmissions. Methods: The program was implemented due to excessive repeated COPD readmissions in an attempt to reduce frequency of readmits. Once COPD patients are admitted to the hospital they are assessed for current stage in the disease process and discharge planning is intiated. Patients with a definitive diagnosis of COPD are provided BREATHING EASIER education and referred to the appropriate outpatient program. If COPD is suspected and the patient does not have a FEV1 on record, upon discharge patient is referred to pulmonologist for outpatient pulmonary function testing. The COPD ADVOCATE coordinates transition of care to the outpatient setting, arranges high tech respiratory equipment (bi-pap, non-invasive vent) for the home, and conducts post discharge calls to those with the highest risk for readmission, ensuring a smooth transition of care. Referral is also made to the embedded outpatient case manager for ongoing follow up. Results: Implementing the care management program has led to a reduction in COPD readmissions and increased overall patient satisfaction scores. Prior to implementation of the program, COPD all cause readmission rate was 22%. Since program implementation COPD all cause readmission rate has decreased to 16%. Conclusion: Evidence based practice and collaboration across the continuum enhances quality care, patient safety, and patient satisfaction. This has been achieved thru the use of electronic medical record and the establishment of the medical home practices. Collaboration between the inpatient acute care setting and the outpatient setting has aided in the transition of care for this patient population.
Keywords:
medical home; COPD; continuum
Repository Posting Date:
15-Jan-2015
Date of Publication:
15-Jan-2015
Other Identifiers:
LEAD14PST85
Conference Date:
2014
Conference Name:
Leadership Summit 2014
Conference Host:
Sigma Theta Tau International, the Honor Society of Nursing
Conference Location:
Indianapolis, Indiana, USA
Description:
Leadership Summit 2014 Theme: Personal. Professional. Global. Held at the Indianapolis Marriott Downtown, Indianapolis.
Note:
Items submitted to a conference/event were evaluated/peer-reviewed at the time of abstract submission to the event. No other peer-review was provided prior to submission to the Henderson Repository.

Full metadata record

DC FieldValue Language
dc.language.isoen_USen
dc.type.categoryFull-texten
dc.typePresentationen
dc.titleThe COPD Journey: Care Management Across the Continuumen_US
dc.contributor.authorMcGee, Allisonen
dc.contributor.authorRicks, Nicholeen
dc.contributor.departmentPi Nuen
dc.author.detailsAllison McGee, RN, BSN, MSN, allison.mcgee@wellstar.org; Nichole Ricks, RN, BSN, MSNen
dc.identifier.urihttp://hdl.handle.net/10755/338338-
dc.description.abstractSession presented on Friday, September 26, 2014: Purpose: The purpose of the care management program is to provide patients and family members with a safe and smooth transition from the acute care environment to the outpatient setting. The significance of the care management program is to improve a patient's quality of life while living with chronic obstructive pulmonary disease (COPD). The goals include, "BREATHING EASIER" education to empower patients to take control of their disease process, referral to appropriate outpatient programs, and reducing hospital readmissions. Methods: The program was implemented due to excessive repeated COPD readmissions in an attempt to reduce frequency of readmits. Once COPD patients are admitted to the hospital they are assessed for current stage in the disease process and discharge planning is intiated. Patients with a definitive diagnosis of COPD are provided BREATHING EASIER education and referred to the appropriate outpatient program. If COPD is suspected and the patient does not have a FEV1 on record, upon discharge patient is referred to pulmonologist for outpatient pulmonary function testing. The COPD ADVOCATE coordinates transition of care to the outpatient setting, arranges high tech respiratory equipment (bi-pap, non-invasive vent) for the home, and conducts post discharge calls to those with the highest risk for readmission, ensuring a smooth transition of care. Referral is also made to the embedded outpatient case manager for ongoing follow up. Results: Implementing the care management program has led to a reduction in COPD readmissions and increased overall patient satisfaction scores. Prior to implementation of the program, COPD all cause readmission rate was 22%. Since program implementation COPD all cause readmission rate has decreased to 16%. Conclusion: Evidence based practice and collaboration across the continuum enhances quality care, patient safety, and patient satisfaction. This has been achieved thru the use of electronic medical record and the establishment of the medical home practices. Collaboration between the inpatient acute care setting and the outpatient setting has aided in the transition of care for this patient population.en
dc.subjectmedical homeen
dc.subjectCOPDen
dc.subjectcontinuumen
dc.date.available2015-01-15T13:35:50Z-
dc.date.issued2015-01-15-
dc.date.accessioned2015-01-15T13:35:50Z-
dc.conference.date2014en
dc.conference.nameLeadership Summit 2014en
dc.conference.hostSigma Theta Tau International, the Honor Society of Nursingen
dc.conference.locationIndianapolis, Indiana, USAen
dc.descriptionLeadership Summit 2014 Theme: Personal. Professional. Global. Held at the Indianapolis Marriott Downtown, Indianapolis.en
dc.description.noteItems submitted to a conference/event were evaluated/peer-reviewed at the time of abstract submission to the event. No other peer-review was provided prior to submission to the Henderson Repository.-
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