Key result
ED-based INSPIRED COPD outreach yields low referrals but is linked to ~54% fewer ED visits.
Why the study?
The feasibility of expanding the INSPIRED COPD Outreach Program™ into the emergency department to reach patients with AECOPD discharged from the ED was unknown.
Does the INSPIRED-ED program improve care transitions and reduce ED visits in patients with AECOPD discharged from the ED?
Does the INSPIRED-ED program improve care transitions and reduce ED visits in patients with AECOPD discharged from the ED?
Expanding a home-based COPD outreach program to the emergency department improved care transitions and reduced ED visits, though recruitment in the ED setting proved challenging.
ED expansion of INSPIRED appears feasible; leaves open whether utilization reductions extend to emergency settings and requires prospective trials.
Background: The Halifax-based INSPIRED COPD Outreach Program™ is a facility-to-community home-based novel clinical initiative that through improved care transitions, self-management, and engagement in advance care planning has demonstrated a significant (60%–80%) reduction in health care utilization with substantial cost aversion. By assessing the feasibility of expanding INSPIRED into the emergency department (ED) we anticipated extending reach and potential for positive impact of INSPIRED to those with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) who avoid hospital admission. Methods: Patients were eligible for the INSPIRED-ED study if >40 years of age, diagnosed with AECOPD and discharged from the ED, willing to be referred, community dwelling with at least one of: previous use of the ED services, admission to Intermediate Care Unit/Intensive Care Unit, or admission to hospital with AECOPD in the past year. We set feasibility objectives for referral rates, completion of action plans, advance care planning participation, and reduction in ED visit frequency. Results: Referral rates were 0.5/week. Among eligible patients (n=174) 33 (19%) were referred of whom 15 (M=4, F=11) enrolled in INSPIRED-ED. Mean (SD) age was 68 (7) years, post-bronchdilator FEV 1 44.2 (15.5) % predicted, and Medical Research Council (MRC) dyspnea score 3.8 (0.41). We met feasibility objectives for action plan and advance care planning completion. Frequency of subsequent ED visits fell by 54%. Mean (SD) Care Transition Measure (CTM-3) improved from 8.6 (2.0) to 11.3 (1.3), P =0.0004, and of 14 patients responding 12 (86%) found the program very helpful. An additional 34 patients were enrolled to our regular program from those referred but ineligible for INSPIRED-ED (n=27) or unwilling to participate (n=7). Conclusions: INSPIRED-ED outcomes were generally positive, however referral and enrollment rates were lower than anticipated. Despite the potential of early self-management education, the ED may not be the ideal recruitment setting for home-based programs. Our findings underline the importance of conducting preliminary work to ascertain best settings for implementing new self-management education initiatives.
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Gillis et al. (2017) studied Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) (n=15). INSPIRED COPD Outreach Program (INSPIRED-ED) was evaluated on Feasibility objectives for referral rates, completion of action plans, advance care planning participation, and reduction in ED visit frequency. Expanding the INSPIRED COPD Outreach Program to the ED yielded low referral rates (0.5/week), though among 15 enrolled patients, ED visits fell by 54% and care transition scores improved (P=0.0004).
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