Please select the eligibility criteria that correspond to the clinical trial below.
Title: The European Quality of Care Pathways Study: The Impact of a Care Pathway for Exacerbation of Chronic Obstructive Pulmonary Disease (COPD) : an International Cluster Randomized Controlled Trial." (Www.E-P-A.Org)
Brief Summary: Care pathways, a complex intervention to (re)organise, standardize and evaluate care processes, are used worldwide and in different kinds of settings. Although their international use, the impact is unclear. The European Quality of Care Pathways Study is the first international cluster Randomized Controlled Trial on the effect of care pathways for COPD patients.

The hypothesis is that teams who work with care pathways for COPD patients deliver care that is more compliant to evidence based key interventions, have better patient outcomes and higher scores on team indicators than teams who do not work with care pathways.


Options:
A: Inclusion Criteria:

* Patient at one of the participating primary care clinics (at least 1 visit in past 12 months)
* Age 40 and older
* Speaking English or Spanish
* Plan to continue to be seen at current clinic and to not leave the area for \>2 months anytime in the next 9 months or to be absent at 9 or 15 months
* COPD defined as ever having had a post-bronchodilator Forced Expiratory Volume in 1 second/Forced Vital Capacity (FEV1/FVC) \<.70 of FEV1/FVC of .70 to .74 and diagnosis of COPD by the study pulmonologist
* Willingness to attempt spirometry
* At least moderate COPD, defined as at least one of the following:

  * Ever Forced Expiratory Volume in 1 second (FEV1) \< 80% predicted
  * 1 or more emergency department (ED) visit for COPD exacerbation in past 12 months
  * 1 or more hospital stays for COPD exacerbation in past 12 months
  * 1 or more prescriptions for oral prednisone for a COPD exacerbation in past 12 months
  * Ever on home oxygen therapy
  * Ever outpatient percutaneous oxygen saturation of \</=88%
  * Ever outpatient partial pressure of oxygen (ppO2) by arterial blood gas (ABG) of \</=55mm Hg
  * At least 3 outpatient visits for COPD in past 12 months AND (a current COPD Assessment Test (CAT) score of \>/=10 OR an modified Medical Research Council (mMRC) score of \>/=2).
  * Currently using tiotropium inhaler or combination inhaled corticosteroid and long-acting beta agonist

Exclusion Criteria:

* Unable to participate in the study due to mental or physical impairment
* Severe or terminal illness that precludes focus on COPD
* No phone
B: Inclusion Criteria:

* Community dwelling patients eligible for NMS (aged from 14 years starting a new medicine for asthma/COPD, diabetes (Type 2), antiplatelet/anticoagulation or hypertension).

Exclusion Criteria:

* Patients collecting a repeat prescription for a medicine (i.e. not new) for asthma/COPD, type 2 diabetes mellitus (T2DM), antiplatelets/anticoagulants or hypertension
* Patients collecting a medicine where the only change from the previous medicine involves a dosage or formulation change only
* Participants who are unable to understand patient/participant study documents
* Participants who are unable and unwilling to provide written consent / assent
C: Inclusion Criteria:

1. Be 18 years or older
2. Be able to provide informed consent
3. Be admitted to the Hospital of the University of Pennsylvania or Penn Presbyterian Medical Center
4. Have a smartphone or tablet compatible with activity tracking devices
5. Plan to be discharged to home

Exclusion Criteria:

Have no medical condition which prohibits them from ambulating or plan for any medical procedure over the next 6 months that would prohibit them from ambulating.
D: Inclusion Criteria:

Inclusion criteria on cluster level are:

1. Written agreement to participate in the study;
2. Agreement that a care pathway for COPD will not be developed and used within the time frame of the study when randomized in the control group.

Inclusion criteria on patient level are:

1. Written informed consent;
2. All consecutive admissions with COPD exacerbation;
3. Hospitalization for at least 48 hours;
4. Moderate, severe or very severe COPD;
5. Each patient will be included only once in the study at initial hospitalization, even if the patient had been hospitalized more than once.

Exclusion Criteria:

Exclusion criteria on patient level:

1. Admission required to intensive care unit;
2. Need for Invasive Positive Pressure Ventilation (IPVV).

Inclusion criteria on multidisciplinary team level:

1. Team members are involved in direct patient care responsibilities for COPD;
2. Minimum representation of the core disciplines according to COPD literature;

Answer: D