Skip to Main Content
 

Global Search Box

 
 
 
 

Files

File List


29273.pdf (3.49 MB)

ETD Abstract Container

Abstract Header

Reliable Adherence of a COPD Care Bundle Mitigates System-level Failures and Reduces COPD Readmissions

Zafar, Muhammad A
http://rave.ohiolink.edu/etdc/view?acc_num=ucin1522419463545034

Abstract Details

2018, MS, University of Cincinnati, Medicine: Clinical and Translational Research.
Importance: Although COPD readmissions adversely affect patient outcomes and health care costs, effective interventions to reduce readmissions often elude large health systems. Objectives: i) To identify care delivery failures for COPD patients readmitted within 30 days and create a COPD care bundle to reduce these failures. ii) To achieve 90% adherence to the bundle through improvement science to decrease COPD readmissions. Setting: University of Cincinnati Medical Center is an 800-bed academic regional referral health center and a safety net hospital. The COPD 30-day all-cause readmission rate was 22.7% per month from August 2013 to September 2015. Method: We performed a cross-sectional study of COPD 30-day readmissions from 10/2014 to 3/2015 to identify failures in care delivery. To identify needs at discharge, we interviewed readmitted COPD patients. We reviewed published literature to identify best practices. Then, we formed a multidisciplinary team to create a 5-element COPD care bundle designed to mitigate system failures and meet patient needs. Using quasi-experimental study design and `Model for Improvement’, we redesigned care delivery through sequential Plan-Do-Study-Act cycles to improve adherence to the bundle. Interrupted Time-series analysis was performed using statistical process control (SPC) chart. Measures: Bundle compliance and all-cause 30-day readmissions. Results: In cross-sectional review, 27 patients had 44 readmissions. Median time to readmission was 7 days. COPD was the most common readmission diagnosis (55%). 42 system-level failures were identified during the index admissions. The most prevalent failures were inappropriate inhaler regimen at discharge, late or nonexistent follow-up appointments, and sub-optimal discharge instructions. Patient interviews revealed confusing discharge instructions, especially regarding inhaler use. The COPD care bundle elements were: i) appropriate inhaler regimen, ii) 30-day inhaler supply, iii) inhaler education on the device available post-discharge, iv) follow-up appointment within 15 days and v) standardized patient-centered discharge instructions. Adherence to bundle achieved 90% reliability at 5.5 months. COPD 30-day readmission rate decreased from 22.7% to 14.7% with system-shift on SPC chart. Patients who received the complete bundle had a readmission rate of 10.9%. Conclusion: System-level failures and unmet patient needs are modifiable risks for COPD readmissions. Mitigation of system-level failures through improvement science reduces COPD readmissions.
Erin Haynes, Dr.P.H. (Committee Chair)
Evaline Alessandrini, M.D. (Committee Member)
Mark Eckman, M.D. (Committee Member)
Ralph Panos, M.D. (Committee Member)
42 p.
Surgery
COPD; Quality Improvement; Readmissions

Recommended Citations

Citations

  • Zafar, M. A. (2018). Reliable Adherence of a COPD Care Bundle Mitigates System-level Failures and Reduces COPD Readmissions [Master's thesis, University of Cincinnati]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1522419463545034

    APA Style (7th edition)

  • Zafar, Muhammad. Reliable Adherence of a COPD Care Bundle Mitigates System-level Failures and Reduces COPD Readmissions. 2018. University of Cincinnati, Master's thesis. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=ucin1522419463545034.

    MLA Style (8th edition)

  • Zafar, Muhammad. "Reliable Adherence of a COPD Care Bundle Mitigates System-level Failures and Reduces COPD Readmissions." Master's thesis, University of Cincinnati, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1522419463545034

    Chicago Manual of Style (17th edition)

ucin1522419463545034
382
© 2018, all rights reserved.
This open access ETD is published by University of Cincinnati and OhioLINK.