On the ROAD to better COPD outcomes

This post was authored by Kristen Willard, MS, Vice President of Population Health & Care Delivery at the COPD Foundation.

Samuel Louie, MD directs the UC Davis Asthma Network (UCAN) and the ROAD Center. ROAD (Reversible Obstructive Airway Diseases) includes COPD and the Asthma-COPD Overlap Syndrome. He currently serves as Director, Department of Respiratory Care at UC Davis Medical Center and is Medical Director for the California Society for Respiratory Care. His research interests include asthma, COPD, pulmonary rehabilitation and clinical outcomes in chronic disease management. From his personal philosophy of care: “Empathy is not an occupational hazard for me. The treatment of my patients’ diseases may be impersonal, but the education and care of every patient I have is completely personal. When you can’t breathe, nothing else matters.”

For those who might not be familiar, can you tell us a little about the ROAD program at UC Davis?

Dr. Louie: The UC Davis ROAD or Reversible Obstructive Airways Disease program was conceived to address the health care disparities and unmet needs in patient education and patient safety for the COPD patient population captured by UC Davis Health in Northern California. ROAD was launched in 2011 with a grant from the University of California, Office of the President (UCOP) and AstraZeneca to help COPD patients with the most immediate need and danger for morbidity and mortality: those people hospitalized for acute exacerbations of COPD. The primary outcome goal was to reduce 30-day hospital readmissions for COPD, and provide a framework for other UC hospitals to implement their own programs, if successful. Hospitalizations are very frightening experiences for COPD patients who are physically exhausted, emotionally drained, and feel their very life is threatened.

The ROAD program (Project ROAD Service) for inpatients offers immediate help and education with a certified COPD Case Manager who is a Registered Respiratory Therapist (RRT) working with the UC Davis Hospitalists and a dedicated pulmonologist. This one-stop, in-hospital INTERDISCIPLINARY patient care team service aims to efficiently and effectively educate patients and their families during the hospitalization about WHAT they must know about COPD, HOW to PARTICIPATE in their own healthcare, and RECOGNIZE acute exacerbations early. All patients received an individualized written COPD action plan, direct access to the COPD Case Manager via pager, and learn HOW to keep safe from repeated exacerbations.

We focus on PATIENT SAFETY through this personalized case management and expert bedside teaching by the RRT COPD Case Manager who help each COPD patient navigate transitional care activities to make the home a safer place to live and coordinate transitional health care, including referrals to Pulmonary Rehabilitation and timely followup with their primary care clinic specialist in the UC Davis Health Primary Care Network.

What have the outcomes looked like for the ROAD program?

Dr. Louie: Excellent! UC Davis is nationally recognized for the ROAD program. Most important, our COPD patients and their families recognize our impact on their lives. UC San Diego, UC San Francisco Fresno, Loma Linda University, Sutter Health System in Northern CA, and many hospitals nationwide have adopted our approach to patient safety and reducing COPD readmissions. UC Davis received the prestigious US News & World Report recognition for Excellence in COPD Care in 2015, 2016 and 2017, one of the few nationwide and the only institution in California so distinguished for exceeding clinical excellence and patient safety benchmarks for three consecutive years. The benchmarks included the rate of hospital readmissions after 30 days and mortality.

What have been the keys to the success of this work? Are there any tools or resources you've found indispensable in your work with COPD patients?

• Building an INTERDISCIPLINARY clinical infrastructure with healthcare professionals with great empathy and clinical experience and expertise: RRTs, MDs, RNs, social workers and discharge planners
• ROAD COPD Curriculum, stressing reversibility of lung function, improvement in quality of life (HRQoL), more time without symptoms, more engagement in meaningful social activities, and a long-term partnership with UC Davis Health
• AARC-certified Registered Respiratory Therapist COPD Case Managers who act like firefighters in the patient's battle against COPD
• ABCDEF Education Tool (read more here)
• UC Davis Pulmonary Rehabilitation program, nationally certified
• (916) 816-COPD pager for patient questions
• The COPD Foundation and their COPD360Social for expert resources, education and social networking

What advice would you have for healthcare providers who are building similar programs from the ground up?

• Realize nothing can be built without raising healthcare institutional and public awareness. COPD lives matter!
• Ask leaders at your hospital what is their response to a disease that has passed stroke as the 3rd leading cause of death in the US, kills an American every 4 minutes, kills more women than men, is preventable, treatable and partially reversible?
• Visit UC Davis and join patient rounds with the RRT COPD Case Managers to experience firsthand the hope we can give COPD patients.
• Employing RRTs is the most fiscally responsible and viable business model, engaging highly trained and skilled respiratory care specialists as COPD educators and managers.
• Employing personal input from COPD patients is essential to build the patient-centered program and services THEY need to achieve visibility, connection and purpose in the world again.

Why is being patient-centered so important to your work?

Dr. Louie: This is the MOST IMPORTANT question! Big data in healthcare often lacks the patient's perspective. We must integrate the VALUES and PREFERENCES of every COPD patient!

Everything we do in health care must target the PATIENT with the disease, not the disease in the patient. Nothing else could possibly matter more than our COPD patients' quality of life and their safety. I have learned everything I know about COPD from patients, not from textbooks or published guidelines, which are so generalized that they cannot apply to everyone. I have said many times that ALL patients are created equally DIFFERENT. This requires that physicians and providers listen to each patient with curiosity and empathy, to let them tell their stories, and have the courage to do what I call a clinical trial of ONE.

People with COPD and their families taught me that they all have stories to tell, but encounter problems to clearly describe their fight for breath. Add that to the prevailing concept that COPD is irreversible and healthcare professionals feel less inclined to do more. Diabetes and heart disease are no less irreversible. Why discriminate against COPD?

Our COPD patients deserve all the credit for producing the outcomes with the lessons they learned in the hospital. COPD patients have true GRIT after education and understanding. My message to all COPD patients: It is never too late to ever get educated and to help yourself.

This page was reviewed on March 3, 2020 by the COPD Foundation Content Review and Evaluation Committee