Implementation of Care Plans in the Self-Management of Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) is a progressive disease that involves the obstruction of airflow into the lungs. This disease affects over 60 million people worldwide leading to substantial costs and a high disease burden. Self-management with care plans has a positive impact on reducing exacerbations, improving quality of life, and reducing readmissions however, there is a gap regarding the best person and process for implementation of a care plan. Accordingly, the goals of this evidence-based quality improvement project were to initiate care plans prior to hospital discharge and provide education and follow-up phone calls to reduce 30-day readmissions and improve quality of life over 12 weeks in adult patients with moderate to severe COPD. The project focus was the implementation of a care plan with education to support participants in caring for themselves in the event of increased symptoms. Thirty-day readmission rates of the participants were compared to the project site. Pre and post quality of life was measured using the COPD Assessment Test (CAT). Other evaluated measures included unplanned healthcare use and exacerbation rate. The participants experienced lower 30-day readmission rates compared to the site. There was an overall improvement in quality of life among the participants. Though there was a number of exacerbations and unplanned healthcare visits, all occurred greater than 30-days of discharge. The participants expressed improved understanding regarding recognizing exacerbation and medication utilization. Implementing care plans effectively reduced costly health care utilization and improved quality of life supporting their utility in outpatient settings.



Work Title Implementation of Care Plans in the Self-Management of Chronic Obstructive Pulmonary Disease
Penn State
  1. Mary Beth Thier
  1. COPD
  2. DNP Project
  3. Chronic Obstructive Pulmonary Disease
  4. action plan
  5. Self-management
  6. Care plan
License All rights reserved
Work Type Project
  1. Lorah D. Dorn, Ph.D., CRNP
  2. Madeline F. Mattern, D.N.P., FNP-C, CNE
  3. Jacqueline A. Mogle, Ph.D.
Publication Date 4/2/2019
  1. COPD Self-Management
DOI doi:10.26207/5erk-c046
Deposited April 02, 2019




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