Canadian INSPIRED Program Improves COPD Home-based Care, Reduces Hospital Use

Better and more adequate home-based care for patients with chronic obstructive pulmonary disease (COPD) can significantly improve their quality of life and reduce the need of hospital-based treatments.

This finding was reported by the Canadian Foundation for Healthcare Improvement (CFHI) as a result of its INSPIRED initiative, implemented to help the transfer of chronic care from the hospital to the home.

“Too often, people with chronic diseases like COPD end up in hospital because the care they need is not available in the community,” Maureen O’Neil, president of CFHI, said in a news release. “INSPIRED provides the services patients and their families tell us they need to manage their disease outside of hospital and now we are expanding this innovative collaboration to benefit more patients.”

INSPIRED stands for Implementing a Novel and Supportive Program of Individualized Care for Patients and Families Living with REspiratory Disease. It is a hospital-to-home model of care that provides specialized support for patients living with moderate-to-severe COPD and their families to enhance their confidence to manage the disease.

The latest INSPIRED results showed a significant reduction of 64 percent in hospital readmissions, and 52 percent in emergency department visits among more than 2,000 COPD patients who integrated the program since it was implemented in 2014-2015.

“These results are important because they show we can keep people with chronic disease out of the hospital by partnering with them to reinvent the way we deliver care so it meets their needs,” said Maria Judd, vice president of programs at CFHI.

“All Canadians who use and pay for the healthcare system, not just those with a chronic disease, will benefit from the emergency department and hospital bed capacity this approach will free up as it spreads across the country,” Judd added.

Supported by these recently announced positive first results, the CFHI has selected six teams from across Canada to implement the next phase of the project, which includes:

• Alberta Health Services (Edmonton Zone)
• Manitoba (including Winnipeg Regional Health Authority, Interlake-Eastern Regional Health Authority and Prairie Mountain Health)
• Joseph Brant Hospital and Caroline Family Health Team (Burlington, Oakville and Hamilton, Ontario)
• Horizon Health Network (New Brunswick)
• Nova Scotia Health Authority (NSHA)
• Health PEI

The foundation is going to make available a total of $1.4 million to support expanded development of the existing INSPIRED programs to reach even more patients with COPD. By March 2019 this initiative is expected to reach an additional 2,300 Canadian patients with advanced COPD in 39 hospitals and 13 primary care organizations.

COPD patients who visit emergency departments or are hospitalized are contacted by healthcare teams who invite them to join the program. From this point on, patients receive written action plans to help them manage disease symptoms, at-home self-management education, and psychosocial support, as well as advance care planning when required.

Patients who are enrolled in the program have a daytime phone number they can call for support, and they also receive follow-up phone calls.

“The more you know, the more control and the less stress you have,” said Charlotte Starratt, the wife and caregiver of an INSPIRED patient in Sackville, Nova Scotia. “The questions we’re able to ask and are encouraged to ask is a big thing. It’s about getting control of a whole new way of life.”

An independent analysis revealed that if the program can reach 5,800 patients annually by 2021, it would be possible to prevent approximately 70,000 emergency department visits and 400,000 hospital bed days.

This would represent a total savings of about $688 million in acute care costs. This means that for every dollar invested in INSPIRED, $21 in hospital-based costs could be prevented.

“CFHI is offering its support and we encourage others to join us in making change happen,” the foundation stated.