The Development, Implementation and Evaluation of Clinical Pathways for Chronic Obstructive Pulmonary Disease (COPD) in Saskatchewan

Overview

Chronic obstructive pulmonary disease (COPD) has substantial economic and human costs. To minimize these costs high quality guidelines have been developed. However, development of guidelines alone rarely results in changes to practice. One method of integrating guidelines into professional practice is the use of clinical pathways (CPWs).

The investigators are working with local stakeholders to develop CPWs for COPD with the aims of improving quality of care and guideline adherence while reducing healthcare utilization. The CPWs will utilize several steps including: standardizing diagnostic training, implementing and unifying common components of chronic disease care, coordinating the provision of education and reconditioning programs, and ensuring disease specific care utilizes and delivers evidence-informed practices. In addition, the investigators have worked to identify evidence-informed strategies for the implementation of the CPWs. Efforts are underway to tailor these implementation strategies for the local context.

The investigators will conduct a three-year quantitative health services research project using an interrupted time series (ITS) design in the form of a multiple baseline approach with control groups. The CPW will be implemented in two Saskatchewan health regions (experimental groups) and two health regions will act as controls (control groups). The experimental and control groups will each contain one urban and one rural health region.

This project is expected to improve quality of life and reduce healthcare utilization. The project will also provide evidence on the effects of CPWs in both urban and rural settings. If the pathways are found effective the investigators will work with all stakeholders to implement similar CPWs for the remaining health regions in the province.

Study Type

  • Study Type: Observational
  • Study Design
    • Time Perspective: Prospective
  • Study Primary Completion Date: September 30, 2020

Interventions

  • Other: Clinical Pathway (CPW)
    • CPWs bring the available evidence to a range of healthcare professionals by adapting guidelines to a local context and detailing the essential steps in the assessment and care of patients.

Arms, Groups and Cohorts

  • Experimental – CPW (Urban)
    • We are working with Regina Qu’Appelle Health Region (RQHR), a primarily urban health region, to develop and implement a clinical pathway (CPW). The CPW will improve care through the following steps: standardizing diagnostic, coordinating and unifying common components of chronic disease care, coordinating the provision of education and reconditioning programs, and ensuring disease specific care utilizes and delivers evidence-informed practices.
  • Experimental – CPW (Rural)
    • Following implementation in RQHR a rural health region will be chosen as an intervention site for a second CPW. The CPW will improve care through the following steps: standardizing diagnostic, coordinating and unifying common components of chronic disease care, coordinating the provision of education and reconditioning programs, and ensuring disease specific care utilizes and delivers evidence-informed practices.
  • Control – Standard Care (Urban)
    • Saskatoon Health Region (SHR) will act as the urban control site. No attempts will made to alter care in SHR and therefore patients will continue to receive the current standard of care.
  • Control – Standard Care (Rural)
    • Following implementation in RQHR a rural health region will be chosen to act as the rural control site. No attempts will made to alter care in this health region and therefore patients will continue to receive the current standard of care.

Clinical Trial Outcome Measures

Primary Measures

  • Quality of Care
    • Time Frame: 36 months
    • Operationalized as hospital readmission rates and and emergency department (ED) presentation rates

Secondary Measures

  • Healthcare Utilization
    • Time Frame: 36 months
    • Operationalized as hospital admission rates and hospital length of stay
  • Guideline Adherence
    • Time Frame: 36 months
    • Operationalized as scheduled primary care provider and specialist visits

Participating in This Clinical Trial

Inclusion Criteria

  • All individuals with diagnosed chronic obstructive pulmonary disease (COPD)

Exclusion Criteria

  • N/A

Gender Eligibility: All

Minimum Age: 18 Years

Maximum Age: N/A

Investigator Details

  • Lead Sponsor
    • University of Saskatchewan
  • Collaborator
    • Lung Association of Saskatchewan
  • Provider of Information About this Clinical Study
    • Principal Investigator: Thomas Rotter, Research Chair in Health Quality Improvement Science – University of Saskatchewan

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