Work

Measuring national expansion of an interprofessional COPD program across rural Veterans Affairs Medical Centers

Year: 2025

Type: preprint

Abstract: BackgroundChronic Obstructive Pulmonary Disease (COPD) is a leading cause of mortality in the United States, disproportionately affecting Veterans and patients residing in rural communities. Despite evidence-based practices, fewer than one-third of individuals with COPD receive guideline-concordant care. In response, a pharmacist-driven COPD care bundle—COPD Coordinated Access to Reduce Exacerbations (CARE)—was scaled to rural Veterans Affairs Medical Centers (VAMCs).MethodsFrom October 2022 to June 2024, COPD CARE was implemented at 14 rural VAMCs through the Department of Veterans Affairs. Early sustainment was evaluated using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. Reach, adoption, and implementation were assessed through frequency of COPD CARE encounters, clinician participation, and delivery of evidence-based COPD practices respectively. A time series analysis was used to track changes in outcomes longitudinally. Effectiveness was measured by comparing time to primary care follow-up after a COPD exacerbation among patients enrolled in COPD CARE versus those not enrolled. A mixed methods effects logistic regression analysis was conducted to examine the relationship between COPD CARE participation and access to care.ResultsAll RE-AIM measures improved significantly by early sustainment. Compared to early implementation, there was an average monthly increase of 97.8 patient visits (a 1.8-fold increase) and engagement of 81 additional clinicians (a 2.7-fold increase) from the early implementation phase by the early sustainment phase. The mean number of evidence-based practices delivered per visit rose from 2.2 during pre-implementation to 8.6 in the early sustainment phase (p < 0.001). Patients referred to COPD CARE were more likely to receive follow-up within 90 days of hospital discharge (74.0% vs. 45.4%, p < 0.001) and were seen 6.7 days sooner than those not referred, on average (p < 0.001).ConclusionsCOPD CARE demonstrated sustained improvements in the adoption of pharmacist-driven services, delivery of evidence-based COPD practices, and timeliness of primary care follow-up. Further evaluation is warranted to optimize long-term sustainability and refine strategies for scaling pharmacist-led COPD interventions in rural healthcare settings.

Source: Research Square

DOI: 10.21203/rs.3.rs-7559115/v1