New "ROAD" program provides path to breathing easier
UC Davis takes steps to reduce hospital admissions for COPD
UC Davis Medical Center has launched a new program to reduce symptoms and hospital stays for people with chronic obstructive pulmonary disorder, or COPD -- a common cause of hospitalization and the third-leading cause of death in the U.S.
Through the Reversible Obstructive Airway Disease (ROAD) program, hospitalized COPD patients receive individualized treatment planning, one-on-one education, specialty-care referrals, pulmonary rehabilitation and day-time pager access to a registered respiratory care practitioner. The goal is to prevent acute exacerbations -- episodes when symptoms rapidly get worse, often leading to emergency department visits and hospitalization.
"Most hospitals do not provide integrated post-discharge care for COPD patients," said Samuel Louie, professor of pulmonary and critical care medicine and founder of the program. "As a result, readmissions are common, and mortality rates are as high as 24 percent for those in intensive care."
According to Louie, nearly one out of every five patients 40 years of age or older in U.S. hospitals has a diagnosis of COPD, with total annual health-care costs in the U.S. close to $50 billion.
"COPD may not be curable, but it is reversible," said Louie. "We brought together hospitalists, nurses, pharmacists, discharge planners and respiratory therapists in a united mission to improve outcomes for patients and reduce the costs of care at the same time."
So far, the ROAD program has enrolled more than 40 patients; just one has been readmitted to the hospital.
A national leader in treating lung diseases, Louie explained that people with COPD have chronic bronchitis that causes airway obstruction, emphysema that causes air to be trapped in the lungs or, more commonly, both. Most often caused by cigarette smoke, COPD leads to progressively labored breathing. It is typically diagnosed when the disease is moderate to severe, or when the volume of air that can be exhaled from the lungs in one second is less than 70 percent of what would be predicted.
"It's insidious," said Claudia Vukovich, a registered respiratory practitioner at UC Davis. "Patients don't notice at first that they are becoming more short of breath. And the disease may not be on the radars of those who quit smoking a while ago or who have only been exposed to second-hand smoke. It's usually when they are mapping the locations of benches in the mall so they know where they can sit and catch their breath that they seek help."
Often worried that they can't get enough air, COPD patients tend to prefer to be sedentary and avoid social activities.
"It's exactly the opposite of what they need," said Louie, noting that interaction with other patients in pulmonary rehabilitation is an important part of recovery.
"We've seen remarkable improvements and much less need for hospitalization with targeted exercise therapy and a community of empathy and support," he added.
Vukovich trained a team of UC Davis respiratory care practitioners as COPD case managers using the successful approach she helped develop for the UC Davis Asthma Network (UCAN). The philosophy is simple: Help COPD patients regain their daily lives with personalized treatment plans combined with immediate access to experts when necessary. When hospitalization is required, the ROAD team can streamline admission.
"Too often, COPD patients do not get the treatment they need in a meaningful, respectful way," said Louie. "'Smoking-related' doesn't mean 'shouldn't be treated.' Every COPD patient and their families deserve the best possible quality of life."
For more information about ROAD or COPD treatment at UC Davis, call the ROAD program pager at 916-762-COPD.