Improving COPD Care at the University of North Carolina Internal Medicine Outpatient Clinic

The Global Initiative for Chronic Obstructive Lung Disease has encouraged symptom assessment for all chronic obstructive pulmonary disease (COPD) patients and pulmonary rehabilitation for COPD patients with high symptom burden and risk of exacerbations. Pulmonary rehabilitation has been shown to improve their symptoms, quality of life, and exercise tolerance and to reduce readmissions and mortality in patients with a recent exacerbation (≤4 weeks from prior hospitalization). However, many patients never have the opportunity to take advantage of pulmonary rehabilitation because systematic ways of assessing symptoms, identifying symptomatic patients, and referring those who would benefit from pulmonary rehabilitation are lacking. In the University of North Carolina general medicine clinic, symptom assessment and pulmonary rehabilitation referrals were not done prior to this effort. The project’s primary goal was to systematically screen for dyspnea symptoms during all COPD patient encounters, with secondary goals of improving rates of screening for hypoxia, referrals to pulmonary rehabilitation in symptomatic patients, and documentation in the electronic health record