Year of Publication

2016

Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Elizabeth Tovar

Clinical Mentor

Dr. Michelle Pendleton

Committee Member

Dr. Shirl Johnson

Abstract

Background: Chronic obstructive pulmonary disease (COPD) is a leading cause of death in the United States (U.S), with rates in Kentucky among the highest in the nation. Quality care in the primary care setting is key to optimizing the health outcomes of those with COPD.

Purpose: The objective of this study was to establish a baseline of COPD patient care in a primary care clinic. The specific aims of this study were to: 1) describe the demographic and health-related characteristics of patients with COPD who have a primary care provider (PCP) at one Norton Healthcare primary care clinic; 2) explore relationships among key variables; and, 3) evaluate provider adherence to COPD evidence-based practice (EBP) guidelines.

Methods: The study was conducted as a retrospective chart review, including a sample of patients (N=215) from the clinic between January 1, 2015 and December 31, 2015.

Results: Tobacco smokers have more exacerbations than former and never smokers; those with a heart failure (HF) comorbidity were more likely to have had a COPD exacerbation, and were more likely to be hospitalized with a COPD exacerbation; and, those with a diabetes mellitus (DM) comorbidity were also more likely to be hospitalized with a COPD exacerbation. The studied clinic did not meet national benchmarks for bronchodilator therapy, timely PCP follow-up after hospital discharge, or readmission rates.

Conclusion: The results of this study indicate a need for a practice improvement intervention involving program implementation to reduce hospitalizations. Specific aims of the program include: 1) spirometry evaluation in the clinic for objective diagnosis and staging of COPD; 2) optimizing the electronic medical record (EMR) with the addition of COPD templates; and, 3) creating a process for timely follow-up after hospital discharge, particularly for patients with HF or DM.

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