COPD insider

5 simple technologies to bridge the COPD care gap virtually

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Today, COPD care teams are effectively managing patients within each care setting. However, as value-based standards continue to rise, this is no longer enough. Teams face the vital need to drive better outcomes by integrating care between settings. Unfortunately, this extension of care will demand more resources that care teams simply don’t have.

 

Examples of resource limitations:

  • RT limitations: Respiratory therapists can provide great value in bridging COPD care gaps, but, as Amy Shaheen points out, they can’t be everywhere at once. “I think the RT has a definite role in hospitals, emergency rooms, and pulmonary practices,” says Dr. Shaheen. “But from a cost-effectiveness standpoint, it's not feasible to place them in a primary care practice, unless it’s a massive practice of 30,000 to 50,000 people.”

But do these limitations mean that inadequate care is inevitable? Our COPD insiders say no.

 

That’s because they’re exploring virtual technologies that extend their reach, empower patients, and increase quality without increasing resource consumption.

 

Let’s look at some of their extraordinary ideas.

Contributors

Amy Shaheen, MD MSc

Amy Shaheen, MD MSc

Medicine Professor, Division of General Medicine and Clinical Epidemiology, UNC Director of Population Health Services, University of North Carolina School of Medicine
M. Bradley Drummond, MD, MHS

M. Bradley Drummond, MD, MHS

Clinical Associate Professor
University of North Carolina School of Medicine’s Division of Pulmonary Diseases and Critical Care Medicine
Garry Kauffman, RRT, FAARC, MPA, FACHE

Garry Kauffman, MPA, RRT, FAARC, FACHE

RT, Owner

Kauffman Consulting, LLC

Bobbie V. Kumar, MD, MBA, FAAFP

Bobbie V. Kumar, MD, MBA, FAAFP

Medical Director, Swedish Edmonds Urgent Care

Director, Complex Care Management for Vituity

Virtual technologies that bridge the gap

Icon Solution 1 unified systems

Solution: Unified systems that trigger alerts for PCPs when COPD patients are admitted to the ER

Real-world example

One of the challenges that many institutions face is that the PCPs may not be affiliated with the emergency room that the patient has gone to. So, we generated an automatic messaging prompt through our electronic health record, which sends that primary care provider a message that simply says: ‘Your patient was seen and discharged from the emergency department. We know that these patients with COPD have high mortality in the next year. They should be on full maximal inhaled therapies. They should be educated about the appropriate use of their inhalers, and here is some contact and resource information if you think they need to see a pulmonologist.’ We often get replies back that the PCP, especially when they're outside of our system, had no idea the patient was even in the emergency room.” 

M. Bradley Drummond, MD, MHS

 

Clinical Associate Professor
University of North Carolina School of Medicine’s Division of Pulmonary Diseases and Critical Care Medicine

Key benefits check mark icon

Key benefits

  • Integrates diverse stakeholders and drives collaboration between HCPs
  • Enables care teams to engage with more patients, more efficiently
  • Helps reduce readmissions with more-personalized care plans
Icon solution 2 e-consults

Solution: E-consults between providers and patients, and between different providers on the care team

Real-world example

Let's stop rewarding touch time. Providers should be able to do e-consults with each other and say, ‘I'm worried about this patient. Can you look at their spirometry? I've got him on all this, what would you suggest?’ And we should be able to look at it and say, ‘I would try this and this and this,’ without actually seeing the patient, because there are so many barriers to coming into the clinic.”

Amy Shaheen, MD MSc

Medicine Professor, Division of General Medicine and Clinical Epidemiology, UNC Director of Population Health Services, University of North Carolina School of Medicine
Key benefits check mark icon

Key benefits

  • Integrates diverse stakeholders and drives collaboration between HCPs
  • Enables care teams to engage with more patients, more efficiently
  • Helps reduce readmissions with more-personalized care plans
Icon solution 3 virtual RTs

Solution: Virtual RTs

Real-world example

One of the concepts I'm toying with now is a virtual respiratory therapist. It may not be cost-effective to have a respiratory therapist on staff, but we can engage a trained RT to virtually spend 15 minutes of time with a patient while they’re in their own home, through whatever technology makes the most sense. It might be a simple phone call, but Skype or FaceTime or another visual technology would be much better. I'd be curious if, in the pulmonary practice or family practice, there would be value for having that expert who could beam in literally only on an as-needed basis [and] at no cost to the practice?”

Garry Kauffman, MPA, RRT, FAARC, FACHE

RT, Owner

Kauffman Consulting, LLC

Key benefits check mark icon

Key benefits

Enables RTs to engage with more patients, more efficiently

Helps reduce readmissions with more access to vital therapy

Note: Services like virtual RTs may not be permitted in some states. Be sure to review your state's legal considerations before implementing a program.
Icon solution 4 how to resource videos

Solution: Centralized databases of how-to resource videos for patients

Real-world example

We've spent a lot of time developing a COPD resource website that has easy links to how-to videos, so that when you don't have the opportunity to engage a certified trainer with a patient, you can at least show the patient, in a standardized way, how that inhaler is supposed to be used. I think the wealth of patient champions moving things forward is great in some places, but in some settings, those people or resources may not be available. In those cases, we have to decentralize those resources a little bit and find new ways to educate patients.”

M. Bradley Drummond, MD, MHS

 

Clinical Associate Professor
University of North Carolina School of Medicine’s Division of Pulmonary Diseases and Critical Care Medicine

Key benefits check mark icon

Key benefits

  • Empowers patients to better self-manage
  • Spares care teams from having to re-educate patients every time questions arise
  • Standardizes best-practice education
  • Helps reduce readmissions by ensuring correct use of therapies
Icon solution 5 ai navigator tool

Solution: Artificial intelligence navigator tool via an app or Alexa

Real-world example

We’re currently developing an artificial intelligence navigator in the form of an app. The idea is to check in with patients and ask questions like, ‘Have you taken your medications today? Did you go to your follow-up, etc.?’ And if  the patient describes that they're exhibiting symptoms, or if they are having problems with their medications, those concerns are routed to a real COPD navigator who can help answer those questions. Education can be provided and we can ensure that patients’ questions are being answered. But the tool can also take that information back to the primary care team to let them know that a question was asked, this was what was done, and this is how we should go forward.”

Bobbie V. Kumar, MD, MBA, FAAFP

Medical Director, Swedish Edmonds Urgent Care

Director, Complex Care Management for Vituity

Key benefits check mark icon

Key benefits

  • Standardizes best-practice engagement
  • Integrates diverse stakeholders and drives collaboration between HCPs
  • Enables care teams to engage with more patients, more efficiently
  • Helps reduce readmissions by ensuring quality care

How to make your case for a technological investment

New technologies can help offset major costs, but they may involve upfront costs of their own. Before implementing a digital health solution, or campaigning for one, it’s important to perform due diligence to justify the time and investment. 

 

When appealing to administration or other stakeholders, consider the criteria to the right. Focus on how your idea keeps the patient at the center of care and drives better outcomes for all.

Patient

Icon patient

Clinical relevance

Improving care pathways and long-term health

Behavior

Influenceing behavior patients and providers

Value

Improving finqncial outcomes

Making your case: The COPD virtual technology checklist

Make sure you can answer these questions:
Check mark icon

Clinical relevance

How does this idea:

  • Provide measurable improvements in clinical outcomes?
  • Improve patient quality of life?
  • Improve communication between patient and provider?
  • Overcome practical barriers to health faced by your patients?
  • Empower patients to self-manage?
  • Streamline care across settings to ensure unbroken quality?
Check mark icon

Behavior

  • Is the technology intuitive and easy to use?
  • Does it integrate seamlessly into patients’ and providers’ lives, using existing technologies?
  • How does it help patients and providers bridge care gaps across settings?
  • How will the new behavior support organizational goals?
  • What are potential barriers to adoption?
  • How easily can the tool be modified to better fit patients’ lives?
  • How easily can the tool be modified to better fit providers’ workflows?
Check mark icon

Value

How does this idea:

  • Reduce the cost of care?
  • Prevent readmissions?
  • Drive better resource utilization?
  • Empower efficient patient management?
  • Support measurable financial justification?

Virtual tools. Real results.

 

Today’s new challenges beg for new solutions. To integrate care delivery and reduce COPD readmissions, we need to embrace virtual care.

 

Each tool mentioned above was designed to help reduce COPD readmissions by helping to manage care more efficiently and effectively. Dr. Drummond believes a highly functioning practice can reduce COPD readmission costs by 15-20%. He also believes that 30% of referrals to COPD pulmonologists can be prevented by “interventions that empower the PCP.”

 

Ultimately, digital tools can help patients take control of their own wellness. Dr. Kumar says that with an AI navigator, “patients felt empowered, they felt like they understood their disease, they felt connected to somebody who could get them to the resources that they needed.” The payoff: “We are now seeing a significant drop in that post-acute spend that we otherwise wouldn't have seen.”

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