Chronic Obstructive Pulmonary Disease Case Study

The medical home for pulmonary disease patients will meet the needs at every stage of the disease process through patient-centered relationship-based support and navigate services. Chronic obstructive pulmonary disease, COPD, consist of a group of diseases that restrict airflow and cause breathing problems (Egan et.la, 2003). Emphysema and chronic bronchitis are two major entities composing COPD and is currently the third leading cause of death in the United States (COPD by the Numbers, n.d.).

The team would consist of the physician, nurse practitioner, registered nurse and a respiratory therapist. The team will navigate patients through programs, resources and pulmonary rehabilitation. The registered nurse will meet with the patient prior to discharge to evaluate and refer them to the appropriate services. The nurse practitioner and the respiratory therapist will see the patient within 48 of hours after discharge. The nurse practitioner and respiratory therapist will evaluate the needs at home and enroll the patient in pulmonary rehab. After the initial visit, contact will be established with the patient primary care physician to notify of patients acceptance into program. …show more content…
The patients could also use computer based education and support groups by enrolling in programs developed for pulmonary patients. Classes could include smoking cessation, self-care and chronic disease management.
The success of the design will be measured by monitoring readmission into the hospital of the patients who are participating in the program. Comparing the admission data a year prior to entry into the program followed with a year out to measure cost