Pulmonary Rehabilitation: A Quality Improvement Evaluation

Pulmonary Rehabilitation: A Quality Improvement Evaluation by Michelle Groth MSN, FNP-BC, ACNP-BC MS, Indiana State University, 2005 BS, University of Michigan Flint, 2001 Proposal Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University May 2020 Abstract COPD is a progressive, multifaceted, chronic disease with steadily increasing worldwide rates of prevalence, morbidity and mortality, making improved COPD care a global health priority. Current practice guidelines are in place, but the literature continues to demonstrate inadequacies in practice, for example the inconsistent use of pulmonary rehabilitation (PR). The purpose of the project was to conduct a quality improvementCOPD is a progressive, multifaceted, chronic disease with steadily increasing worldwide rates of prevalence, morbidity and mortality, making improved COPD care a global health priority. Current practice guidelines are in place, but the literature continues to demonstrate inadequacies in practice, for example the inconsistent use of pulmonary rehabilitation (PR). The purpose of the project was to conduct a quality improvement initiative evaluation of the PR program at a hospital in south-central Idaho. The practicefocused question was: What impact has implementation of a PR program had on COPD care in the area? Donabedian’s framework for healthcare quality evaluation was the theoretical foundation for the project; de-identified data from the hospital and PR program were used. Sources of evidence included current clinical practice guidelines for COPD and PR programs, literature on current COPD care practices, and national standards for rate of COPD readmissions. Results indicated a 21% increase in PR use since program inception, improvements in functional capacity in those who completed at least 10 weeks of PR as measured by the objective measures of max METS and get up and go scores and a higher probability than chance that participating in PR improved the subjective functional capacity measures of strength, endurance and balance. Due to lack of access to readmission data prior to initiation of the PR program, a direct relationship between PR use and readmission rates could not be determined. This project resulted in positive social change through increasing awareness and understanding of the essential role of PR in COPD care. Pulmonary Rehabilitation: A Quality Improvement Evaluation by Michelle Groth MSN, FNP-BC, ACNP-BC MS, Indiana State University, 2005 BS, University of Michigan Flint, 2001 Proposal Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University May 2020 Dedication I dedicate this project to my children and grandchildren. Wanting to be the best version of myself for you has been the driving force behind all I have done. Without your love, patience, encouragement and support, none of this would have been possible! Being your Mom and Grammy has taught me that we should always dream big, work hard, love harder and try to have a little fun along the way! Acknowledgments I would like to thank Dr. Mattie Burton for her guidance, support and, when needed, gentle nudge forward! It sometimes seemed I would never finish because life kept getting in the way, but you were always there with kind words of understanding and encouragement! I would also like to thank Monique Middlekauff, PhD for agreeing to be my preceptor for the clinical portion of the program, for all of her support and patience while I worked through the process of refining the project, and for all of the time spent helping me to better understand all that is pulmonary rehab, the process for quality improvement evaluation and selection of the most appropriate data. Finally, I would like to thank Laura Tivis, PhD, CCRP for all that she has done to help me move this project forward through to completion! I never would have made it through writing all the statistical analysis language without you! From the beginning you have been a pleasantly unexpected source of unwavering support and encouragement, often going above and beyond what your job requires you to do! Each of you have helped me to fully understand what a strong, intelligent, educated female leader should look like and I feel extremely blessed to have had the privilege of working with you!