A standardized inpatient management care path that incorporates best practices helped improve care quality for patients with acute exacerbation of chronic obstructive pulmonary disease (COPD) at the Cleveland Clinic, according to recent research presented at the American Thoracic Society International Conference in Dallas.

“Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is associated with increased expense, mostly due hospitalization costs,” Uddalak Majumdar, MD, from the Cleveland Clinic in Cleveland, Ohio, and colleagues wrote in their abstract. “Lack of standardized management and non-adherence to guideline-directed treatment may lead to poor outcomes and increase cost.”

Presentation at conference. Source: Getty

Dr. Majumdar and colleagues analyzed patients with AECOPD who were admitted to the Cleveland Clinic between January 2017 and July 2018. Of 814 patients admitted during that time, the researchers placed 288 patients (35.2%) on the Cleveland Clinic COPD Care Path, a standardized inpatient management care plan. Researchers studied the impact of the change on outcomes and care with regard to 30-day readmission, in-hospital mortality, length of stay, antibiotic administration, corticosteroid use, post-discharge management. Patients were excluded from the study if they received hospice care, a lung transplant, or left the hospital against medical advice.

“The Cleveland Clinic COPD Care Path consists of an admission order set that incorporates multi-disciplinary management, evidence-based medications, and post-discharge integrated care,” Dr. Majumdar and colleagues said in their abstract. “Use of the order set was voluntary but encouraged with a best practice alert.”

The researchers found patients using the care path had better rates of scheduled (99.0% vs. 83.9%; P < .001) and completed (42.4% vs. 33%; P = .10) post-discharge appointments. In addition, those following the care plan had higher rates of administered oral antibiotics (78 patients vs. 53 patients; P < .001) and use of corticosteroids (97.2% vs. 74.8%; P < .001) than patients who did not use the care path (64.8% of patients).

The care path patients also had higher rates of COPD education by a pharmacist (72.9% vs. 12.2%; P< .001), bedside delivery of medications (26.7% vs. 17.5%; P = .002) and long-acting bronchodilator prescriptions (94.4% vs. 82.8%; P < .001) at discharge compared with those patients who did not use the care path.

The researchers noted there were no significant differences in 30-day readmissions, length of stay, or mortality between groups.

“The findings from this retrospective study suggest that utilization of a standardized care pathway in inpatient management of AECOPD is associated with better quality of medical care during hospitalization and facilitates transitions of care. However, length of stay and 30-day readmission rates are unaffected.”