COPD Discharge Bundle Delivered Alone or Enhanced Through a Care Coordinator (PRIHS)
Pulmonary Disease, Chronic Obstructive
About this trial
This is an interventional health services research trial for Pulmonary Disease, Chronic Obstructive focused on measuring COPD, AECOPD, Discharge care bundle, Patient Care Bundles
Eligibility Criteria
Inclusion Criteria:
- Medical diagnosis of COPD;
- Male or female, 50 years of age and over, admitted to ED or hospital for an exacerbation of COPD. The age limit is imposed to reduce the chances of enrolling patients with asthma.
- Any stage of severity;
- Not being treated previously under the COPD care bundle
Exclusion Criteria:
- Patients with a diagnosis other than COPD will be excluded.
Sites / Locations
- Foothills Medical Centre
- Rockyview General Hospital
- Royal Alexandra Hospital
- University of Alberta Hospital
- Red Deer Regional Hospital Centre
Arms of the Study
Arm 1
Arm 2
Arm 3
No Intervention
Active Comparator
Experimental
Usual Care
COPD discharge care bundle
COPD discharge care bundle & coordinator
During the initial stepped wedge phase, all sites will receive usual care. There is currently no standardized discharge care bundle for COPD in Alberta. Some electronic patient information sheets do exist; however, their content is general and use is limited. It is expected that a vast majority of patients will transition to the community on a sub-optimal medication regimen, with limited referral to additional outpatient programs and no formal follow-up organized with a primary care provider (e.g., "F/U prn" or "F/U with Fam MD").
COPD discharge care bundle: Ensure patient has demonstrated adequate inhaler technique Send discharge summary to family physician office and arrange follow-up Optimize and reconcile prescription of respiratory medications Provide a written discharge management plan, and assess patient's and care giver's comprehension of discharge instructions Refer to pulmonary rehabilitation Screen for frailty and comorbid condition(s) Assess smoking status, provide counseling and refer to smoking cessation program, where appropriate
COPD discharge care bundle as listed for active comparator arm enhanced with care coordinator support.