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Home-Based Prescribed Pulmonary Exercise in Patients with Stable Chronic Obstructive Pulmonary Disease
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Care coordination for veterans with COPD: a positive deviance study.

Ekaterina Anderson1, Renda Soylemez Wiener, Kirsten Resnick

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Summary
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High-quality care coordination and communication significantly reduce hospital readmissions for chronic obstructive pulmonary disease (COPD). Improving these organizational factors can enhance COPD patient care and outcomes.

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Area of Science:

  • Healthcare Management
  • Health Services Research
  • Pulmonology

Background:

  • Reducing hospital readmissions for chronic obstructive pulmonary disease (COPD) is a key healthcare priority.
  • Organizational factors influencing variations in COPD readmission rates are not well understood.
  • Care coordination is a potential factor contributing to inter-site differences in readmission rates.

Purpose of the Study:

  • To investigate whether inter-site differences in care coordination influence chronic obstructive pulmonary disease (COPD) readmission rates.
  • To examine provider perspectives on COPD care within Veterans Affairs (VA) sites with varying readmission rates.

Main Methods:

  • A mixed-methods positive deviance study design was employed.
  • Three Veterans Affairs (VA) sites in the lowest quartile and three in the highest quartile for risk-adjusted COPD readmission rates were selected.
  • Semistructured interviews were conducted with primary and specialty care providers at low (n=14) and high (n=11) readmission sites.

Main Results:

  • Providers at low-readmission sites reported practice environments with high relational coordination, characterized by quality relationships and communication.
  • Providers at low-readmission sites experienced fewer structural barriers to collaboration, such as patient volume.
  • Specific readmission reduction initiatives were mentioned by providers at all sites, but relational coordination quality differed significantly.

Conclusions:

  • The quality of relational coordination and the presence of structural barriers are key differentiators between high- and low-readmission sites for COPD care.
  • Organizational reforms focusing on enhancing relational coordination and mitigating structural barriers can improve COPD care.
  • These findings may also be applicable to improving care quality for other chronic conditions.