De-implementing Inhaled Steroids to Improve Care and Safety in COPD (DISCUSS COPD)
Treatment of Chronic Obstructive Pulmonary Disease
About this trial
This is an interventional other trial for Treatment of Chronic Obstructive Pulmonary Disease focused on measuring Quality Improvement, Quality Enhancement Research Initiatives, QuERI, Interventional, Multicenter, Inhaled corticosteroids, Pneumonia, Safety, De-implementation, Respiratory Tract Diseases, Lung Diseases, Lung Diseases, Obstructive, Pulmonary Diseases, Chronic Obstructive COPD
Eligibility Criteria
Inclusion Criteria:
Provider:
Primary care provider (medical doctor/osteopathic physician, nurse practitioner, physician assistant [MD/DO, NP, PA]) assigned to a PACT from VA Puget Sound Health Care System or Edith Nourse Rogers Memorial Veterans Hospital (Bedford VA).
Patient:
- Patient is a Veteran who is assigned a VA PCP and has received Rx for an inhaled corticosteroid within the past 180 days.
- Patient has an inpatient or outpatient diagnosis of COPD in the prior two years.
- Patient has undergone spirometry in the past 5 years that indicates either no airflow obstruction or mild to moderate airflow obstruction indicated by a forced expiratory volume 1 (FEV1)/[greater of forced vital capacity (FVC) or vital capacity (VC)] =< 0.7 & FEV1% predicted >= 30%.
Exclusion Criteria:
Patients:
- Very severe airflow obstruction (<30% FEV1 % predicted)
- Severe disease as indicated by 1 inpatient COPD exacerbation in the year prior
- Severe disease as indicated by 2 outpatient COPD exacerbations in the year prior
- International Classification of Diseases (ICD) 9 and/or 10 diagnosed or clinically indicated asthmatics
- Significant bronchodilator response on spirometry (>12% increase in FEV1 post bronchodilator; >375 mL post-bronchodilator improvement)
Sites / Locations
- VA Bedford HealthCare System, Bedford, MA
- VA Puget Sound Health Care System Seattle Division, Seattle, WA
Arms of the Study
Arm 1
Arm 2
Other
No Intervention
Proactive patient-tailored electronic consult (E-consult)
Usual care
Primary care clinicians receive patient-tailored guideline concordant treatment recommendations, including orders and rationale to discontinue inhaled corticosteroids.
Standard practice (usual care). Primary care providers treat their patients as usual.