Introduction
Describing the Gap
Nowadays, the number of patients with COPD is constantly growing. COPD is one of the primary reasons for the disability and death of patients. The costs associated with the treatment of exacerbations of the disease in the US rise year by year. All these factors make it essential to address the gap in the quality of care for patients with COPD. The specific gap in healthcare delivery to patients with COPD deals primarily with poor quality of treatment due to the lack of coordination between medical specialists and home health services as well as between physicians and care managers (Rinne et al., 2019). The second block of problems stems from the lack of EHR interoperability, due to which community providers cannot access medical information rapidly, resulting in delayed care (Rinne et al., 2019). Finally, the fields of responsibilities of each actor are not clearly defined, which leads to duplicative efforts and a waste of costly resources.
The Gap’s History
The problem of poor communication between diverse services is rooted in history. Indeed, when there was no internet communication, all papers related to patients’ health had to be delivered manually. Though the situation has improved, some home health services still use fax machines to obtain the necessary information or documentation. Another related problem is that software at different medical clinics is not always compatible. Thus, for example, radiographs conducted outside a specific clinic may not be properly read, which results in a waste of resources to redo the examination (Rinne et al., 2019). The lack of EHR interoperability is also historically conditioned as, before the introduction of digital technologies into healthcare, it was practically impossible to keep all health-related paper documents from different clinics in one place. Nowadays, the problem is mainly related to the concerns about personal data which cannot be disseminated.
Socioeconomic Background
COPD treatment is relatively expensive, and only some of the costs are covered by insurance. As a result, patients from low-income families have difficulties paying the additional expenses associated with the disease. Thus, socioeconomic background plays a considerable role in access to COPD treatment as not all patients can afford all the procedures recommended by their physician that are not covered by the insurance.
Effects of the Gap and Potential Implications
The gap in access to treatment for low-income groups directly affects their health prospects and life expectancy rate. The studies show that inadequate or untimely treatment leads to complications such as pneumonia, bronchiectasis, pneumothorax, pulmonary embolism (PE), and respiratory failure (Ritchie & Wedzicha, 2020). Improper treatment is associated with “trends toward increases in exacerbations, HCRU, and costs […] observed as airflow limitation worsens” (Wallace et al., 2019, p. 205). If the gap in access is not addressed, it will result in low quality of life for patients with COPD, higher expenses on maintenance therapy, and higher mortality rates. The gap in quality of care that stems from the lack of coordination and EHR interoperability leads, in turn, to higher exacerbation rates. Moreover, it is a waste of resources when patients have to undergo the necessary procedures twice due to the absence of conformity within the medical system.
Existing Initiatives
There are certain initiatives to address the gap in access to proper treatment of patients with COPD. First of all, to ensure coordination between diverse specialists, outpatient rehabilitation programs have been actively used since the 1960s (Vaishali et al., 2019). Secondly, COPD discharge bundles have been introduced after discharge treatment (Rinne et al., 2019). Finally, multidisciplinary lung disease programs have been developed (Rinne et al., 2019). These initiatives aim to improve coordination between different departments and clinics, minimize waste efforts, and unite various medical measures into a single cohesive treatment plan and rehabilitation program.
Development of the Initiatives
Outpatient rehabilitation programs grew out of the need to provide COPD patients with a way to cope with the disease while they stay at home. The first rehabilitation programs were developed in the late 1960s (Vaishali et al., 2019). Before that, the readmission rate among COPD patients was extremely high, leading to an excessive workload on medical workers and patients’ inability to live normally. Being unable to take care of themselves, they had to rely on hospital staff in any emergency. Outpatient rehabilitation programs allow people to significantly enlarge their planning horizons and ultimately improve their quality of life.
These programs include telehealth pulmonology rehabilitation sessions during which patients may discuss their needs, barriers to rehabilitation efforts, difficulties they experience, and their inhaler education progress. Another element of rehabilitation programs is post-discharge nursing care, which presupposes “follow-ups to assist with appointment scheduling, referrals, and need assessment and follow-ups with frequent exacerbators” (Rinne et al., 2019, para 15). These measures improve coordination between different specialists and significantly reduce the workload on patients when they have all their visits and examinations organized for them.
COPD discharge bundles were elaborated to help patients cope with the disease in a home environment. As a rule, they include “pulmonary rehabilitation referral, vaccinations, inhaler education, and a post-discharge action plan” (Rinne et al., 2019, para 15). Out of these measures, education is especially important as it allows patients to feel empowered to cope with the disease and significantly reduces the medical resources needed to sustain a patient’s well-being. A post-discharge action plan, however, is suitable only for those patients who feel able to put it into action; for those in the later stages of the disease, it is preferable that the arrangement of referrals and scheduling is performed by medical workers.
Multidisciplinary lung disease programs aim primarily to improve the coordination between different specialists and departments. Indeed, when a patient is seen by diverse specialists within one program, they get a comprehensive care plan that would take into account different aspects of the disease. Moreover, multidisciplinary lung disease programs provide a platform for the communication of diverse specialists so that the treatment plan they finally agree on is carefully elaborated to exclude all possible complications. For a patient, it means enhanced care and fewer visits to clinics and medical departments. Typical elements of multidisciplinary lung disease programs include the “robust use of electronic consultations” between doctors and healthcare providers and “hospital interdisciplinary huddles to discuss patient needs” (Rinne et al., 2019, para 18). These elements improve communication between healthcare workers, which results in enhanced patient care.
Required Resources
The outlined initiatives necessitate the use of resources to bring them to life. Thus, the initiative of elaborating outpatient rehabilitation programs presupposes additional expenses on the work of a nurse who will arrange patients’ referrals, examinations, tests, and visits to diverse specialists. Moreover, telemedicine technologies will have to be actively used to monitor a patient’s state of health and the difficulties they may experience. The initiative presupposes additional spending on telehealth technologies and the work of IT specialists. COPD discharge bundles presuppose the active involvement of educators who will teach patients methods of breathing as well as nurses who would draw up patient post-discharge action plans. In this case, the additional expenses presuppose payment for these specialists’ work. Multidisciplinary lung disease programs presuppose the creation of an online healthcare infrastructure within which doctors from different clinics or departments can communicate and share the medical documentation of a patient.
Limitations of the Initiatives
While all mentioned initiatives are valid, they have their drawbacks. Such measures as COPD discharge bundles and outpatient rehabilitation programs do not solve the problems of patients with COPD in their terminal forms. These patients need constant care, and no consultations can replace proper readmission treatment. Multidisciplinary lung disease programs, in turn, though effective for all kinds of patients, are difficult to organize due to the lack of specialists in COPD and an additional workload on those doctors who are actively engaged in COPD treatment. Moreover, tele-technologies rarely allow the exchange of such specific documentation as radiographs, which significantly hampers the possibilities of telemedicine for comprehensive consultations.
Regulation
Currently, the outlined initiatives are regulated by state healthcare departments, which creates additional difficulties due to the absence of a cohesive system within which the initiatives can be regulated. State laws about the proper scheme of treatment and rehabilitation of COPD patients significantly differ. Therefore, the outlined initiatives will have to undergo expertise in each state separately to determine whether they correspond to the adopted regulations. Adopting a single approach to the treatment and rehabilitation of patients would make the process much easier and more beneficial for the patients.
Conclusion
To conclude, such initiatives as outpatient rehabilitation programs, COPD discharge bundles, and multidisciplinary lung disease programs have proved to be effective in addressing the gap in the quality of care of patients with COPD. The possible positive circumstances these programs envisage by far outweigh the additional resources their implementation necessitates. However, there are no comprehensive regulations of these initiatives across the country, which makes their application more difficult in each given state.
References
Rinne, S. T., Resnick, K., Wiener, R. S., Simon, S. R., & Elwy, A. R. (2019). VA provider perspectives on coordinating COPD care across health systems. Journal of General Internal Medicine, 34(1), 37-42. Web.
Ritchie, A. I., & Wedzicha, J. A. (2020). Definition, causes, pathogenesis, and consequences of chronic obstructive pulmonary disease exacerbations. Clinics in chest medicine, 41(3), 421-438. Web.
Vaishali, K., Sinha, M. K., Maiya, A. G., & Bhat, A. (2019). The initial steps in pulmonary rehabilitation: How it all began? Lung India, 36(2), 139–141. Web.
Wallace, A. E., Kaila, S., Bayer, V., Shaikh, A., Shinde, M. U., Willey, V. J., Napier, M. B. & Singer, J. R. (2019). Health care resource utilization and exacerbation rates in patients with COPD stratified by disease severity in a commercially insured population. Journal of managed care & specialty pharmacy, 25(2), 205-217. Web.