Guest Perspective: Hospitalists’ role in providing high quality care for patients admitted with COPD
Posted on July 19, 2016 |
Guest author Valerie G. Press, MD, MPH, FHM, FAAP, FACP is Assistant Professor, Internal Medicine-Pediatrics at the University of Chicago and is a member of the PRAXIS Advisory Board. Dr. Press is an active researcher with interests in health literacy, health disparities, adolescent health, women’s health and community outreach. Her current research projects focus on patient self-management education and health literacy in patients with asthma and COPD. She is also an author of one of our most popular Resource Repository items: the Society of Hospital Medicine COPD Implementation Toolkit.
The Centers for Medicare & Medicaid Services’ Hospital Readmission Reduction Program (HRRP) has already had one very important success, which is putting COPD on hospitals’ agendas. Despite being the third leading cause of death and the third leading cause of readmissions among the Medicare population, COPD as a disease had failed to garner the attention that other chronic diseases, such as congestive heart failure, had across the spectrum of care. This attention includes quality improvement initiatives, administrative priorities, pay for performance, among other types of care priorities.
This is not to say work was not being done to understand the current level of care quality across the U.S., as an expert group of researchers and stakeholders had worked for years as part of a multi-stakeholder consortium to understand whether care was consistently being provided at hospitals across the country. Other important research was being done to understand how to improve on the care provided; however, without top-down hospital initiatives, it is difficult to make large-sweeping care transformation changes. Even with this new federal mandate, instant standardization of care or reduction in readmissions will not happen. There simply is not enough evidence to know what elements of a readmission reduction program or quality improvement program will directly lead to improved outcomes. Therefore, it is critical that a wide base of expertise come to the table to develop, implement, study and then improve upon these programs as forward movement takes place.
A key member group of any hospital-based program to improve and standardize the care for patients hospitalized with COPD should be hospitalists. Hospitalists, by definition, are the experts in the hospital at providing care to hospitalized patients. They are physicians on the front line, provide the majority of direct inpatient care, and serve as the care coordinators for hospitalized patients.
This care coordination includes obtaining specialty input from pulmonologists, nurse practitioners, physical therapists, pharmacists, nurses, respiratory therapists, case managers, among others. They are therefore skilled at working with and across medical disciplines and as part of inter-professional teams; however, it is critical to ensure that hospitalists and hospitalists-to-be continue to receive education and training on the existing evidence and best practices to ensure ongoing an improved quality of care for hospitalized patients with COPD. As leaders of or participants on these inter-professional care teams, their expertise can help build and inform improved care quality.
Although the HRRP financial penalty galvanized efforts across the country to improve care and reduce readmissions, we have a ways to go. New financial paradigms, such as bundled care payments, may further help facilitate hospitals’ efforts to improve care, or may serve as barriers, depending on how quickly evidence for best practices on readmissions reduction efforts can be established. Regardless, together, hospitalists and specialists across the wide array of clinical expertise can work with hospital administrators to standardize and transform care to ensure that evidence-based and guideline-informed care is provided and sustained for all COPD patients, in the hospital and as they transition to home after discharge.