Date of Publication

2025

Project Team

Miles Derrick, RN, ATC; Margaret Aitken, DNP, APRN; Alison Bovee, MBA

Abstract

Abstract

Chronic Obstructive Pulmonary Disease (COPD) is the fourth leading cause of death in the United States. COPD accounts for $24 billion in annual healthcare costs, with $900 million spent on emergency department (ED) visits. Inadequate health literacy and disorganized care coordination exacerbate ED utilization and subsequent hospitalizations. At a primary care clinic in northern Vermont, no standardized educational resources or care coordination guidelines existed for patients with COPD. This project aimed to improve care coordination and health education. Participants (n=29) received health education toolkits and subsequent calls to assess knowledge around their health condition and needs. Eleven (n=11) participants chose to review the health education materials which included a health education checklist, corresponding toolkit, and home action plan. Chart reviews indicated 21% of participants experienced an ED visit or hospitalization in the past year. Despite 24% of participants continuing to smoke, only 3% of these smokers had acute care utilization within the past year. Education desired included home action plans (100%), home monitoring equipment (91%), and breathing techniques (64%). Following intervention, 82% expressed intent to use the acute action plan at home. Interventions improved participant engagement and knowledge, fostering self-management strategies. Future initiatives should explore long-term impacts on acute care utilization and expand standardized care pathways for patients with COPD.

Keywords: chronic obstructive pulmonary disease, primary care, care coordination, health education, self-management, hospitalization prevention, health literacy, quality improvement.

Document Type

Dissertation/Thesis

Available for download on Wednesday, April 29, 2026

Included in

Nursing Commons

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