Theses and Dissertations

Date of Award

2007

Document Type

Dissertation - NSU Access Only

Degree Name

Doctor of Education (EdD)

Department

Abraham S. Fischler College of Education and School of Criminal Justice

Advisor

Karen D. Bowser

Committee Member

Charles L. Faires

Committee Member

Maryellen Maher

Keywords

Health Services/Chronic Illness/ Health Promotion/Patient Education

Abstract

The researcher designed this applied dissertation to address two problems. The first problem was the inefficiency of hospital care for individuals with COPD. The review of discharge data showed that about 30% of patients admitted to the medical-surgical units at a community hospital had obstructive lung disease as either a primary or secondary diagnosis. Therefore, a large cohort of patients may benefit from improving hospital care. Clinicians identified five key areas as factors that impacted the care provided to these patients: (a) resources (e.g., personnel with clinical expertise), (b) communication (e.g., process of sharing clinical data and use of treatment plans), (c) measurement (e.g., data about clinical outcomes), (d) physician procedures (e.g., independent decisions about treatment), and (e) hospital procedures (e.g., referrals to pulmonary rehabilitation). One of the purposes of this project was to reduce the variations in clinical process and care provided to individuals admitted to the hospital.

A second problem was the limited opportunity for screening and health education available for individuals with undiagnosed COPD or at risk of developing COPD. Because COPD is an insidious disease and most individuals lose some of their lung function by the time of diagnosis, the identification and education of individuals at risk for developing the disease or who are at the early stages of the disease process is critical.

The proposed COPD disease management program developed by the researcher and validated by the formative and summative committees appeared to be an appropriate solution for the two problems identified in this study. The proposed COPD disease management program involved the key clinical disciplines that provide the majority of care to individuals with COPD, including nurses, physicians, and respiratory therapists. In addition, the development of the COPD disease management program relied on the information from the many internationally recognized, evidence-based clinical practice guidelines for treatment of COPD. The proposed COPD disease management program intended to provide services across the care continuum by including activities for education and screening for those at risk for developing COPD to providing supportive care management for those individuals with end-stage COPD who are approaching death. Finally, the plan for implementing the COPD disease management program has a plan for metrics to evaluate the program that includes clinical, financial, and quality of care outcomes.

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