HOSPITAL SISTERS HEALTH SYSTEM
A new system of screening, counseling and keeping in touch with patients who have chronic obstructive pulmonary disease has cut readmissions by 20 percent at St. Mary's Hospital in Decatur, Ill., the program director says.
Dr. J. Steven Arnold, medical director for the hospital's intensive care unit, organized its COPD program in 2009. Arnold, a pulmonologist, said the hospital wanted to reduce readmissions and offer more consistent care to patients with emphysema and chronic bronchitis.
Decatur is an industrial community in central Illinois with many factories and grain processors. Arnold said Decatur has a higher-than-average incidence of residents who suffer from COPD, partly because of the industrial and agricultural pollutants. But he said the main cause of the illness is the same as it is everywhere — cigarette smoking.
Arnold calls the program "a clinic without walls." It includes a protocol for the emergency room and hospital admissions to screen carefully for COPD, intensive counseling for patients in healthy habits and proper use of medication, and regular follow-ups with a home-health service.
"We knew we were getting readmissions quite frequently, and we wanted to do something more about it," said Arnold, a doctor at St. Mary's for 24 years. "Many of the patients have other medical problems as well. When they go home, how can we be sure they're taking their medications? A lot of our effort is to monitor the patients and make sure they continue to get the therapies they need."
Arnold said having COPD patients meet with dieticians and other specialists can help change habits and slow lung deterioration. He said the project emphasizes exercise, even if a patient does nothing more than walk around the house more often.
"A patient who goes from being in a wheelchair to walking 100 feet has liberated himself," he said. "Any activity is better than none, and it's a key part of treatment."
St. Mary's staff members work with COPD patients on matters of medication and healthier living. A home-health service based at St. John's Hospital in Springfield, Ill., provides follow-up work. Arnold said he also wants all COPD patients to return to St. Mary's six weeks after discharge for follow-up examinations and counseling.
In 2010, the COPD program reached out to area physicians to encourage more screening for COPD. Arnold encourages them to use spirometers to test for lung capacity and health. He said the program has encountered some resistance to that idea, largely because of the expense and operation of spirometers, which measure the capacity of lungs and airways. But he said spirometry helps in detecting early forms of COPD, allowing for faster intervention and better lives for patients.
The program's public-service initiative uses radio spots and other outreach to educate people in the Decatur area about COPD.
Last fall, The Joint Commission gave St. Mary's a Gold Seal of Certification for its COPD project, one of five hospitals in the country so honored. Arnold said the program is collecting data on its work for future reports to the hospital accrediting agency. He said his estimate of a 20 percent reduction in admissions is based upon six months of data.
Kevin F. Kast, president and chief executive of St. Mary's, said the hospital applied to The Joint Commission for COPD program recognition "to enhance the safety and quality of care we provide. We're proud to achieve this distinction."
There is no cure for COPD, and it's a progressive disease. Arnold said hospitals and clinics still can prolong the lives of their patients — and make their lives better.
Crucial, of course, is getting patients to quit smoking cigarettes. Arnold said The Joint Commission has asked his program to begin collecting data on the results of its cessation programs, particularly regarding medications and nicotine-replacement therapies.
"There aren't any magic ways to get people to quit," Arnold said. "We try to get patients to understand the connection between smoking and their illness, and how they can be around longer for their families if they stop."