’INSPIRED’ COPD Outreach Program^TM: Doing the Right Things Right

Abstract

The well-documented gaps between needed and provided care for patients and families living with chronic obstructive pulmonary disease (COPD) mandate changes to clinical practice. The multifaceted evidence-based INSPIRED COPD Outreach Program TM was first implemented in Halifax, Nova Scotia, Canada in 2010 (INSPIRED = Implementing a Novel and Supportive Program of Individualized care for patients and families living with REspiratory Disease) and undergoes ongoing evaluation. By enhancing patient confidence to manage their illness more effectively in their homes and communities, there has been a sustained and substantial reduction in facility-based care in comparison with patient care experience pre-INSPIRED. Sustaining and spreading a program recently designated a leading practice by Accreditation Canada, and especially modifying the program as new evidence emerges, requires integrating and modeling at the 'bedside' both evidencebased medicine ('doing the right things') and quality improvement ('doing them right'). In Canada, where COPD care gaps are common, a new pan-Canadian INSPIRED-based quality improvement program is supporting multidisciplinary healthcare teams to bridge the chasm between evidence and practice by working together to 'do the right things right' in COPD care.COMMENTARY

Expanding The INSPIRED COPD Outreach Program^TM to the emergency department: a feasibility assessment

“…We also met our targets for action plan completion and reduction in facility reliance. Thê50% reduction in ED visits was similar to that reported previously for our regular program 8. Positive participant feedback and the improvements in care transitions maintain our confidence in the INSPIRED program and in its holistic approach.…”

“…Based on the number of patients coded as AECOPD in the local ED electronic coding system, projections from our successful prior recruitment strategy and outcomes of our original INSPIRED program,8,21 the referral rate to INSPIRED-ED was lower than anticipated. We received 19% (33/175) of potential eligible referrals.…”

“…The Halifax-based INSPIRED COPD Outreach Program™, in which self-management enhancement is a primary component, has demonstrated positive potential to alter this cycle among patients enrolled following a hospital admission for a COPD exacerbation 8. Current enrolment exceeds 500 patients.…”

Number Needed To… $ave?

“…6 In other words, 26 patients would need to complete the INSPIRED program to save the healthcare system $100,000, or to allow the healthcare resources to be used for other purposes. This NN$ of 26 is likely an overestimate as we have factored in neither the costs related to the reduction in ED visits nor the savings related to avoided or reduced bed utilization for decedents within our program (~20% of our patients die annually).…”

“…We summarize below, and have reported in detail elsewhere [6], our outcomes in terms of reduced facility usage among patients engaged in the INSPIRED program. Here, we wanted to estimate the number of patients who need to be enrolled and complete the INSPIRED COPD Outreach Program TM to contain or 'save' the system $100,000 through reduced emergency department (ED) visits and hospitalizations.…”