COPD

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death in the United States and, if not treated, can cause serious long-term disability.

While an estimated 24 million Americans suffer from COPD, as many as half remain undiagnosed. But, with early diagnosis and treatment, people with COPD can improve their quality of life and begin to breathe a little easier.

Source: National Institutes of Health website, http://www.nhlbi.nih.gov/health/dci/Diseases/Copd/Copd_WhatIs.html, consulted 12/22/2009.

Program Goals

  • Decrease the need for emergency room visits or hospital admissions through better understanding and control of COPD.
  • Decrease absenteeism and increase productive work time.
  • Help individuals with COPD learn self-management skills to better manage symptoms and increase understanding of how medications work.
  • Increase medically appropriate testing.
  • Smoking cessation to help delay diminishing physical ability and disease progression.
  • Encourage routine visits with primary care provider
  • Maximize the member's engagement and satisfaction with the program.

Program Interventions

  • Telephonic care management provided by specially trained Registered Nurses, with call
    frequency set to individual needs.
  • Provide access to Registered Nurses 24 hours a day, 7 days a week for COPD support.
  • Encourage members to keep physician appointments, follow care plans, and assist them with coordination of care when multiple physicians are necessary.
  • Assess the member's knowledge of COPD and treatments as directed by the physician.
  • Educational materials sent to member based on individual needs.
  • Facilitation of enrollment in face to-face educational programs as needed.
  • Establish an action plan with behaviors that maintain control of diet and promote medication compliance.
  • Proactive goals set by member, with guidance and encouragement from the nurse.
  • Lifestyle coaching using "motivational interviewing" techniques to foster behavior change.
  • Access to website for education and interactive tools.
  • Encourage annual immunizations for prevention of pneumonia and influenza.
  • Facilitate involvement of family/support individuals to maximize success in reaching goals.