Improving the quality of care for patients with chronic obstructive pulmonary disease

Over 26 million Americans have chronic obstructive pulmonary disease (COPD). COPD is a serious lung disease and the third leading cause of death in the United States.

Patients with COPD often live with the condition for decades with daily symptoms of shortness of breath and cough. These symptoms can escalate quickly during episodes known as exacerbations, which can be life-threatening.

While a number of treatments known to improve quality of life and reduce exacerbations have been developed over the years, few patients receive these therapies. Efforts to increase delivery of proven treatments through education and outreach have been unsuccessful, in part due to the competing demands of primary care providers (PCPs) who manage COPD in more than 90% of patients. 

Population management

At the VA Puget Sound Health Services Research & Development, a successful approach was developed where pulmonary specialists  identify patients with COPD, review their medical records, and deliver recommendations to patients’ PCPs. The specialists also send the PCPs unsigned orders so they can deliver the recommended care quickly and easily.

The study team found this system improved delivery of proven therapies and patient’s quality of life.

This method of care delivery is called population management.

However, there are few pulmonary specialists across the country, so, to serve more patients, a pragmatic trial will test pharmacists’ ability to provide population management for COPD relative to pulmonary specialists.

Pharmacists are healthcare providers who are experts in the appropriate use of medications, and they already provide population management for conditions like hypertension and diabetes.

Enhance Quality, Safety and Patient Experience in COPD

The study team will conduct this clinical trial at five medical centers and 38 associated clinics within the Department of Veterans Affairs (VA) in the states of Washington, Oregon, Minnesota, and Massachusetts.

The study will recruit at least 200 PCPs and will randomly assign them to population management by either pulmonary specialists or pharmacists.

Patient-centered economic outcomes

This study has also received supplemental funding to study the patient and caregiver cost burdens of interventions to improve care quality for chronic obstructive pulmonary disease.

Funding for this study is provided by the Patient-Centered Outcomes Research Institute (PCORI). Principal Investigators are Drs. David Au and Lucas Donovan. Co-Investigators include Dr. Laura Feemster and Dr. Allison Lambert. Dr. Joshua Liao serves on the stakeholder advisory board.