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Canadian Respiratory Journal
Volume 20, Issue 5, Pages 351-356
Original Article

Integrated Interdisciplinary Care for Patients with Chronic Obstructive Pulmonary Disease Reduces Emergency Department Visits and Admissions: A Quality Assurance Study

Esther Dajczman,1,2,3 Chantal Robitaille,1 Pierre Ernst,1 Andrew Michael Hirsch,1 Norman Wolkove,1,2 David Small,1 Judy Bianco,3 Hartley Stern,3 and Mark Palayew1

1Airways Centre, Division of Pulmonary Diseases, Jewish General Hospital, McGill University, Montreal, Canada
2Mount Sinai Hospital Center, Cote-Sait-Luc, Canada
3Jewish General Hospital, McGill University, Montreal, Quebec, Canada

Copyright © 2013 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


BACKGROUND: Dedicated programs for the management of chronic obstructive pulmonary disease (COPD) can reduce hospitalizations and improve quality of life.

OBJECTIVE: To investigate whether health care utilization could be reduced by a newly developed integrated, interdisciplinary initiative that included a COPD nurse navigator who educates patients and families, transitions patients through various points of care and integrates services.

METHODS: The present quality assurance, pre-post study included patients followed by a COPD nurse navigator from January 25, 2010 to November 5, 2011. Information regarding emergency department visits and hospitalizations, including lengths of stay, were obtained from hospital databases. Diagnoses were classified as respiratory or nonrespiratory, and used primary and secondary hospitalization diagnoses to identify acute exacerbations of COPD (AECOPD). Paired sign tests were performed.

RESULTS: The sample consisted of 202 patients. Following nurse navigator intervention, significantly more patients experienced a decrease in the number of respiratory-cause emergency department visits (P<0.05), number of respiratory hospitalizations (P<0.001), total hospital days for respiratory admissions (P<0.001), number of hospitalizations with AECOPD (P<0.001) and total hospital days for admissions with AECOPD (P<0.001). Financial modelling estimated annual savings in excess of $260,000.

CONCLUSION: The present quality assurance study indicated that the implementation of an integrated interdisciplinary program for the care of patients with COPD can improve patient outcomes despite the tendency of COPD to worsen over time.