Reducing COPD Readmissions through the Implementation of a Guideline-Based Clinical Pathway: An Evidence-Based Practice Improvement Project

Background: Chronic obstructive pulmonary disease (COPD) is a leading cause of death worldwide. It is characterized by airway inflammation and damage that inhibits appropriate airflow. Exacerbations of COPD (ECOPD) hasten disease progression and have profound impacts on the patients.

Local Problem: East Tennesseans experience higher rates of COPD than the rest of the state. Community members at the project site identified that the inpatient management of ECOPD is inconsistent and discordant with the 2023 Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. The purpose of this project was to reduce readmissions and increase guideline concordance by developing an algorithm to facilitate decision-making.

Methods: The Evidence-Based Practice Improvement Model was used to design and implement the project. A literature search yielded a literature base that supports the use of standardized algorithms to assist decision-making. After four PDSA cycles, the final intervention was the distribution of the Pharmacotherapy Choice Algorithm. Measures included 30-day readmission rate, length of stay, mortality, complications, and pharmacotherapy guideline concordance.

Interventions: The intervention was the design and distribution of a clinical decision-making algorithm to guide pharmacotherapy choice in patients admitted with COPD exacerbation. Providers referred to this algorithm to facilitate medication choice.

Results: There was no effect on readmission rate (p = 1.00), mortality (p = 0.558), complications (p = 0.795), or length of stay (p – 0.401). Guideline concordance did not meet statistical significance (p = 0.445) but did show a clinically significant improvement from 47.5% to 60%.

Conclusion: While the project did not meet its specific aim to decrease 30-day readmissions, guideline concordance for pharmacotherapy choice at discharge improved. This project had several limitations, including an abbreviated implementation time frame and small sample size. The results of this project are not generalizable. This project facilitates studying COPD care at the project site and is sustainable through continued efforts to improve care.