Health Care Team and Patient Perspectives to Peri-Discharge Care in COPD and OSA Overlap

Abstract

Abstract Background Chronic obstructive pulmonary disease (COPD) is highly prevalent with obstructive sleep apnea (OSA) (20–65%). Patients with combined COPD/OSA overlap are at higher risk for readmission and death compared to patients with COPD or OSA alone. COPD readmission reduction programs exist, yet optimal approaches exist. Current readmission programs for COPD rarely address co-morbid health conditions, such as OSA.Objective The aim of this study was to determine peri-discharge barriers in COPD/OSA overlap from the perspective of the acute health care team and patient.Methods Participants were recruited via word of mouth and by in-hospital acute care team members. Patient participants had diagnoses of COPD and OSA confirmed by chart review of pulmonary function studies and in-lab sleep polysomnogram by study team members. Patient consent was performed prior to hospital discharge, and study conducted 72 hours post-discharge via video-conference. Acute care team members were consented via video conference just prior to study participation. All participants were asked to comment on barriers and solutions concerning COPD/OSA acute care and peri-discharge experiences. Interviews were conducted at an urban academic medical center from November 2020 - February 2021.Results There were 35 participants, which included 27 acute care team members representing 6 practice areas, and 8 patients. Of the acute health care workers, most were < 50 years old (81.5%), female (74.1%), White (81.5%), and non-Hispanic (100%). The patient respondents were > 50 years old (100%), male (62.5%), White (62.5%), non-Hispanic (87.5%), and had an average number of Emergency Department (ED) visits in the 2020 calendar year of ~ 8, and ~ 8 hospitalizations. Emerging barrier themes included coordination and communication, efficiency, access and experience, increasing specialty knowledge, and team consensus and management.Conclusions The interprofessional healthcare team should recognize these areas as opportunities for improvement of knowledge and care. Given the medical complexity of patients with COPD and co-morbid conditions such as OSA, including frequency of readmissions, healthcare systems should value these acute care team insights as focus opportunities for change and improvement.