Retrospective Evaluation of COPD Patient Care

The purpose of this project is to evaluate hospital utilisation, patient and service outcomes of a Respiratory Nursing Service to examine current clinical care of COPD. This evaluation aims to identify the important gaps in current clinical care of respiratory chronic disease nursing management. The primary outcomes of this evaluation is to determine the efficacy of clinical care in 2006, 2011, 2013 and 2015 and compare data to current Nursing Best practice guidelines for COPD through the quantification of hospital utilisation for hospital admission, average length of stay, readmission within 28 days, emergency service attendance, outpatient review, use of Hospital and Home (H@H), frequency of exacerbations, disease severity and progression (FEV1: GOLD Classification), number of contacts with the respiratory nursing service and type of contacts with the respiratory nursing service.

Study Overview

• Status: Unknown
• Conditions: Chronic Obstructive Pulmonary Disease

Detailed Description

Study design: This study is a retrospective observational crosssectional study conducted through review of medical records, internal respiratory databases and electronic hospital patient record (OACIS & HOMER) over 3x12 blocks.

Participants: COPD patients from The Queen Elizabeth Hospital(TQEH) Respiratory Nursing Service who were new patients in 2006, 2011, 2013 and 2015 (Jan 1st to Dec 31st ). Data collection: Demographics, clinical data, hospital service utilisation, and clinical outcomes such as exacerbation frequency and disease progression. All data will be extracted into a standardised data extraction form, which a random subset will be checked by a second researcher.

Demographic data will include comparison of % without comorbidities, impact of comorbid conditions using Charleston Comorbidity index isolating diabetes, heart failure, anxiety and depression. Demographic and descriptive data will be given in means + SD and compared using a two-tailed Student t-test. Categorical variables will be compared using chisquared or Fisher exact tests, and when appropriate the MannWhitney Utest for nonparametric data. Statistical significance will be determined using an alpha of p <0.05. All analyses will be examined using SPSS software (version x).

• Study Type: Observational
• Enrollment (Anticipated): 200

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 40 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

New patients to the Respiratory Nursing Service in 2006, 2011, 2013 & 2015 with a diagnosis of Chronic Obstructive Pulmonary Disease

Description

Inclusion Criteria

• any new client or new referral to the Respiratory Nursing Service in the years 2006, 2011, 2013 or 2015 only
• have a diagnosis of Chronic Obstructive Pulmonary Disease

Exclusion Criteria

• not a pre- existing client of the Respiratory Nursing Service
• not having a diagnosis of Chronic Obstructive Pulmonary Disease

Study Plan

How is the study designed?

Number of groups / cohorts

4

Cohorts and Interventions

Group / Cohort
2006 Patients; Comparison of Respiratory Chronic Disease Management provided against recommendations in 2005 Respiratory Nursing Guidelines through documentation
2011 Patients; Comparison of Respiratory Chronic Disease Management provided against recommendations in 2005 Respiratory Nursing Guidelines through documentation. With comparison of data against 2006 results.
2013 Patients; Comparison of Respiratory Chronic Disease Management provided against recommendations in 2005 Respiratory Nursing Guidelines through documentation. With comparison of data against 2006 & 2011 results.
2015 Patients; Group added to reflect recency of practice. Comparison of Respiratory Chronic Disease Management provided against recommendations in 2005 Respiratory Nursing Guidelines through documentation. With comparison of data against 2006 & 2011 results.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Efficacy of care provided by the Respiratory Nursing Service	Compare documentation against the components of 'Nursing Best Practice Guideline, Nursing Care of Dyspnea: The 6th Vital Sign in Individuals with Chronic Obstructive Pulmonary Disease (COPD)'	12 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Impact of respiratory nursing outreach on hospital, patient and service outcomes	Hospital utilisation is determined by hospital admissions, emergency department presentations, length of stay, readmission within 28 days, number of Respiratory Outpatient reviews and use of Hospital at Home. Patient outcomes are frequency of exacerbations, disease severity and progression (FEV1: GOLD Classification), Quality of Life, lung function and exercise tolerance. Respiratory Nurse outcomes are the number and type of contacts performed	12 months
Comorbidity in respiratory nursing	Identify the percentage of patients involved in the Respiratory Nursing Service with COPD who do and do not have a co-morbidity? Identify those with a comorbidity are they Aboriginal and Torres Strait Islander, of Cultural and Linguistic descent or of a low socioeconomic group? Identify the impact of co-morbid conditions using Charlson Comorbidity index isolating diabetes, heart failure, anxiety and depression?	12 months

Collaborators and Investigators

• Sponsor: The Queen Elizabeth Hospital
• Investigators: Study Director: Brian J Smith, PhD, The Queen Elizabeth Hospital

Study record dates

Study Major Dates

• Study Start (Actual): June 1, 2016
• Primary Completion (Actual): December 1, 2017
• Study Completion (Anticipated): June 1, 2018

Study Registration Dates

• First Submitted: April 29, 2015
• First Submitted That Met QC Criteria: May 1, 2015
• First Posted (Estimate): May 4, 2015

Study Record Updates

• Last Update Posted (Actual): May 3, 2018
• Last Update Submitted That Met QC Criteria: May 1, 2018
• Last Verified: May 1, 2018

More Information

Terms related to this study

• Keywords: outreach nursing; respiratory nursing guidelines
• Additional Relevant MeSH Terms: Respiratory Tract Diseases; Lung Diseases; Lung Diseases, Obstructive; Pulmonary Disease, Chronic Obstructive
• Other Study ID Numbers: QElizabethH COPD

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: Available upon request
• IPD Sharing Time Frame: Data analysis is expected to be completed by 30 June 2018
• IPD Sharing Access Criteria: For publication in nursing journal Sharing of information captured as requested