Delivery of educational content through EPIC to increase Pulmonary Rehabilitation in COPD
Robert Kruklitis, MD, PhD; Lorraine Valeriano; Mindy Brosious
According to the American Journal of Managed Care (AJMC), less than 10% of patients with chronic obstructive pulmonary disease (COPD) who may benefit from pulmonary rehabilitation (PR) received a referral from their physician. This appears to be the case even though the benefits of PR include reduced shortness of breath, increased ability to exercise, improved health-related quality of life, and less dependence on health care resources.*
Many patients do not know about PR
When physicians do not discuss PR, patients are unaware of it and its potential positive effects. The other reasons PR is underutilized include low reimbursement from Medicare, lack of convenient rehab centers, and midday scheduling for patients that work. Robert Kruklitis, MD, PhD, and his team decided to tackle the issue at Lehigh Valley Health Network (LVHN) by finding a home-based alternative for COPD patients rather than traveling to a clinic. Their solution was at hand: rich educational content is available to LVHN clinicians through Elsevier, and the MyLVHN patient portal could be its delivery system.
The team started its project by recruiting patients with COPD from LVPG pulmonary practices. If the patients didn’t already have access to MyLVHN, they were assisted with setting it up. The first step was a survey. Questions centered on understanding COPD and the benefits of pulmonary rehabilitation. The survey included questions such as, “Was pulmonary rehab ever recommended to you?” About 50% of respondents answered “no.” Almost 60% of patients surveyed answered “yes” to the question, “Would you be interested in participating in a home-based pulmonary rehab program?”
Positive results for PR and for the portal
After the online rehabilitation program was provided, another survey gathered information on how it was received. The question, “Did you receive/review the exercise information?” resulted in a 100% “yes” response. About 50% of respondents said they would continue the exercises on an ongoing basis, and almost 90% of respondents said they wanted to be monitored with their daily/regular exercise routines.
“The benefits to being monitored include the ability to see other patients like themselves, which could be motivational,” says Dr. Kruklitis. “We might consider a video visit, for example, and watch how patients do the exercises, so we can assure them they are doing them safely.”
The conclusion of the project for Dr. Kruklitis and his team was twofold. First, novel strategies are required to engage COPD patients in pulmonary rehabilitation, and a logical, feasible strategy is readily available. Second, the LVHN portal could be developed as an educational tool. “We have 300,000 people registered on the portal, but many are not using it,” says Dr. Kruklitis. “It has untapped potential for two-way communication.”