Healthcare and difficult breathing are some of the

Healthcare is a system
designed for acute care needs of patients. However, the focus of care has to
turn toward chronic disease management because there is an increasing
occurrence of common chronic diseases, like COPD. A plan has been developed to
effectively and efficiently manage chronic diseases; for proper discharge
planning of COPD patients, to reduce hospitalizations, and the use of emergency
rooms over the next twelve months.

            COPD, or chronic obstructive pulmonary disease, is a lung
disease involving persistent inflammation that causes obstructed airflow in the
lungs. There are five different conditions that make up the category of COPD;
chronic bronchitis, cystic fibrosis, asthma, bronchiectasis, and emphysema.
Coughing, increased mucus production, wheezing, and difficult breathing are
some of the most common symptoms associated with COPD. Those with long term
exposure to cigarette smoke, irritating gases or fumes, or particulate matter
are at a higher risk for developing COPD. As a condition which, “approximately
12 million adults in the U.S. are diagnosed with, and 120,000 die from it each
year. An additional 12 million adults in the U.S. are thought to have
undiagnosed COPD” (National Heart, Lung and Blood Institute, 2013). COPD has a
high prevalence rate in the United States, with the average age affected being
41 years old and older. “About 5.3% of Arizona residents surveyed in 2011
reported having been told by a health care professional that they have COPD” (National
Center for Chronic Disease Prevention and Health Promotion, 2011). Compared to
the rest of the United States, Arizona was on the lower side of COPD prevalence
amongst its residents. Although, the amount of people with COPD does increase
during the winter season because of the winter visitors, who are mainly senior
citizens. In Arizona the same causes put people at a risk for developing COPD, cigarette
smoke is a big cause but so is particulate matter from mining. Arizona has a
fairly large mining industry and occupational inhalants, such as dust and
chemicals, put the workers at a higher risk for developing COPD.

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            In order to help COPD patients from repeated
hospitalizations and emergency room visits, pulmonary rehabilitation is
necessary. Pulmonary rehabilitation is a therapeutic program that helps improve
the life and well-being of patients with COPD. Exercise, education, nutritional
intervention, and support are all key components of pulmonary rehabilitation,
which help patients learn to breathe and perform at their highest level
possible to live an active and healthy life. “Recent data has underlined the
importance of pulmonary rehabilitation in the management of COPD, and firmly
place this concept at the center of efforts to manage patients throughout the
course of their disease” (Casaburi, Morgan, Nici, Reardon, & Rochester, 2005).
To deal with or overcome a disease one has to be able to successful manage said
disease. Pulmonary rehabilitation is a great way to help patients with COPD,
yet there are concerns about the reimbursement for pulmonary rehabilitation.
There are few options in regards to receiving reimbursement, either it is
through health insurance or self-pay by the patients. Even as diagnosis of COPD
continue to rise, the Centers for Medicare and Medicaid Services have recently
decided to decrease the amount of money they will allot for pulmonary
rehabilitation. Many healthcare insurances are following this trend to cut
costs, making it harder for the people suffering from COPD to go to pulmonary
rehabilitation. There is also the concern from the healthcare side of things,
which is fighting to obtain or keep reimbursement. Without receiving payment
for the programs, it is difficult to keep them running and to keep people
employed.

            Taking on the task of decreasing patients’ use of emergency
rooms and reducing hospitalizations over the next twelve-month period, requires
a multidisciplinary team who will each individually and collectively address
the optimal health statuses for their patients. The team members include
exercise specialists, dieticians, physicians, nurses, respiratory therapists,
and social workers. Dieticians will come up with individually tailored
nutritional strategies for the patients, educating patients on nutrition
benefits the patients by informing them how COPD affects their eating habits. “Nutritional
depletion is common in COPD and has a negative impact on respiratory and
skeletal muscle function, contributing to the morbidity and mortality of COPD”
(Butler-Lebair, Brogan, & et. al, 2008). Physicians will adjust medications
as necessary, there are many people over or under medicating themselves, and if
surgery is necessary the physician will help the patient make that decision.
Nurses and respiratory therapists will look after the patients while they are
pulmonary rehabilitation and will complete daily assessments, to take the
patients’ progress, educating patients problem solving skills related to their
disease, administer medications, and to educate the patients on their
medications and possible supplemental oxygen. 
The education of patients aims to enhance outcomes by teaching
self-management skills, and therefore, encouraging self-efficacy and compliance
to the program. Exercise specialists are to help the patients improve exercise
tolerance, “physical training is essential in order to address the disability that
can arise from muscle deconditioning and peripheral muscle dysfunction—caused
by physical inactivity (due to chronic breathlessness and fatigue) and the
systemic effects of chronic respiratory disease” (Casaburi, Morgan, Nici,
Reardon, & Rochester, 2005). Social workers are there to be available
should the need arise for psychological counseling for patients, this program
will require patients to make huge life changes and sometimes this can have a
negative effect on the patients disposition, they also will help find resources
for patients should they need special housing, oxygen deliveries, finding a
job/career, smoking cessation, and other such things required to live a full
life.

            At the beginning of this program every patient will be
assessed to obtain a baseline of the patients’ health. This assessment will
include medical history, arterial blood gas test, a physical exam, oximetry, an
electrocardiogram, lung function tests, and chest x-rays. In order to identify
the success of the discharge plan each patients’ name will be programmed to be
flagged if the go to a hospital or emergency room in the area and logged in a
secure computer program. At the end of each month this list will be assessed to
see which patients have come back so they can be contacted and seen what else
needs to be done for them to reduce these occurrences. Some patients do face
various social and health disparities that may cause them to continually go to
the hospital. These disparities should be identified in order to effectively
develop each patients’ health education and discharge planning. “Lower
educational attainment and household income were consistently related to
greater disease severity, poorer lung function and greater physical functional
limitations in cross-sectional analysis” (Ackerson, Blanc, & et. al, 2010).
Having these factors in mind when coming up with the plans means making sure
the patients’ actually understand what is going to or should happen, giving
them the resources to be able to afford or get help affording medical care,
equipment, or anything else they need to succeed in this program, and if they
cannot afford pulmonary rehabilitation once the insurance stops paying for it
then, they also need the resources on how to do the exercises to improve
physical function as well as better lung function.

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