JUNE 28 - JULY 2, 2020   •  Boston, MA
30 years of Care Transitions Across the Full Continuum

3002 – Take a Deep Breath: The In’s and Out’s of COPD

3002 – Take a Deep Breath: The In’s and Out’s of COPD

Chronic obstructive pulmonary disease (COPD) has long been known as a complex and debilitating disease, not only health wise but also affecting all aspects of life including mental, social and financial.

 Given our increasing understanding of COPD as a diverse and multifaceted disease, it is important to stress that, in this context “complex” means that COPD has a number of intrapulmonary and extrapulmonary components whose dynamic interactions over time are not linear, whereas not all of these components are present in all individuals at any given time-point.

Breaking down COPD care as a case manager using the medical home model we work with the patient, support system, primary, specialists, financial constraints, and environment to establish a plan that includes safety and quality. This list is just a sampling of the variables influencing the care coordination plan.   Using the standards of practice the case manger makes a flexible plan individualized to each patient’s needs and lifestyle.   Some days the plan changes several times as the patient would benefit from home oxygen and does not qualify or the insurance network does not have a provider in your area.  With more access to medical information the informed consumer “wants “what the television says will make him/her feel better.  We work hard to convince the patient that we are the advocate for the best care plan.

Successful outcomes include fewer ER visits, shorter length of stay when admitted, and an improved quality of life.   
Objectives:
1. Define COPD as a complex disease
2. Define using the medical home model to achieve improved outcomes
3. Explain how all aspects of life affect the disease process and outcomes