Impact of Quality Improvement on Care of Chronic Obstructive Pulmonary Disease Patients in an Internal Medicine Resident Clinic.
Robert M Burkes, Takudzwa Mkorombindo, Udit Chaddha, Alok Bhatt, Karim El-Kersh, Rodrigo Cavallazzi, Nancy Kubiak
Author Information
Robert M Burkes: Department of Internal Medicine, University of Louisville, 550 S. Jackson Street, ACB 3rd Floor, Louisville, KY 40202, USA. Robert.Burkes@unchealth.unc.edu.
Takudzwa Mkorombindo: Department of Internal Medicine, University of Louisville, 550 S. Jackson Street, ACB 3rd Floor, Louisville, KY 40202, USA. tmkorombindo@uabmc.edu.
Udit Chaddha: Department of Internal Medicine, University of Louisville, 550 S. Jackson Street, ACB 3rd Floor, Louisville, KY 40202, USA. drudit@gmail.com.
Alok Bhatt: Department of Internal Medicine, University of Louisville, 550 S. Jackson Street, ACB 3rd Floor, Louisville, KY 40202, USA. Alok.Bhatt@nyumc.org.
Karim El-Kersh: Division of Pulmonary, Critical Care, and Sleep Medicine Disorders, Department of Internal Medicine, University of Louisville, 550 S. Jackson Street, Pulmonary, Critical Care and Sleep Disorders Medicine Offices, ACB 3rd Floor, Louisville, KY 40202, USA. Karim.elkersh@louisville.edu.
Rodrigo Cavallazzi: Division of Pulmonary, Critical Care, and Sleep Medicine Disorders, Department of Internal Medicine, University of Louisville, 550 S. Jackson Street, Pulmonary, Critical Care and Sleep Disorders Medicine Offices, ACB 3rd Floor, Louisville, KY 40202, USA. r0cava01@louisville.edu.
Nancy Kubiak: Department of General Internal Medicine, University of Louisville, Palliative Care, and Medical Education, 550 S. Jackson Street, General Internal Medicine and Palliative Care Offices, ACB 3rd Floor, Louisville, KY 40202, USA. Nancy.Kubiak@louisville.edu. ORCID
Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of morbidity and mortality. Guideline-discordant care of COPD is not uncommon. Further, there is a push to incorporate quality improvement (QI) training into internal medicine (IM) residency curricula. This study compared quality of care of COPDpatients in an IM residents' clinic and a pulmonary fellows' clinic and, subsequently, the results of a quality improvement program in the residents' clinic. Pre-intervention rates of quality measure adherence were compared between the IM teaching clinic ( = 451) and pulmonary fellows' clinic ( = 177). Patient encounters in the residents' teaching clinic after quality improvement intervention ( = 119) were reviewed and compared with pre-intervention data. Prior to intervention, fellows were significantly more likely to offer smoking cessation counseling ( = 0.024) and document spirometry showing airway obstruction ( < 0.001). smoking cessation counseling, pneumococcal vaccination, and diagnosis of COPD by spirometry were targets for QI. A single-cycle, resident-led QI project was initiated. After, residents numerically improved in the utilization of spirometry (66.5% vs. 74.8%) and smoking cessation counseling (81.8% vs. 86.6%), and significantly improved rates of pneumococcal vaccination ( = 0.024). One cycle of resident-led QI significantly improved the rates of pneumococcal vaccination, with numerical improvement in other areas of COPD care.
