Breathing Easier: Our Quest to Transform COPD Management in Primary Care

Our latest article in Primary Health Care Research and Development details the route to successful implementation of a novel programme called CONQUEST across three different primary care networks in the US. Our mission? To improve the quality of care for patients living with the chronic lung disease COPD and share what we’ve learned about driving change in routine clinical practice.  

The Imperative for Optimised Care 

What is Chronic Obstructive Pulmonary Disease (COPD) and why is optimizing COPD care important? 

COPD is a progressive lung disease that restricts airflow and makes it difficult to breath. Unfortunately, COPD remains a leading cause of death and disability in the US.  However, evidence shows clear opportunities to intervene earlier and optimize management.  

The CONQUEST Programme: How does it work? 

Using algorithms applied to electronic health records, CONQUEST identifies two groups of patients: those diagnosed with COPD with recent flare-ups, and individuals without a diagnosis but with COPD-like events (e.g., respiratory infections). Once identified, our local primary care teams invite them in for assessment, treatment optimization, and ongoing follow-up.  

Our ‘How-to’ Guide to Making a Difference  

Our article offers a practical overview – or ‘how to’ guide – for those interested in introducing similar programmes to improve chronic disease management. We share which strategies worked, and what to do when faced with challenging realities, such as navigating siloed departments, waiting in long data request queues, and critically, ensuring we don’t overburden primary care networks, many of which are understaffed and cautious about adopting new programs.  

For example, we found that personal communication is key for physician buy-in, but understanding how they prefer to communicate, e.g., a Teams Message versus an e-mail, also matters. We also realised that just as clinicians can get ‘alert fatigue’, patients can also feel overwhelmed by too many automated calls. Listening to feedback, from both patients and providers, is key to success.  

Our 3-Stage Process: From Programme Development to Implementation

Focused on development, stage one details what it took to get CONQUEST off the ground, from selecting steering committees, developing Quality Standards, and defining our target patients, through to assessing current management practices, and formalizing Operational Protocols. Our article also shares how we identified potential healthcare systems and what factors we recommend assessing for feasibility.    

Stage two explains system recruitment and preparation. Key was enlisting clinical champions who advocated for CONQUEST and secured participation in primary care. We outline the steps to obtaining required approvals, ensuring HIPAA compliance, and how we devised operational strategies for optimal patient outreach and clinical decision support delivery.  

Stage three describes the implementation models used across the three systems, each adapted to their capacities while ensuring the core elements are delivered. Underscored in this section is the importance of listening to the local teams and demonstrating willingness to adapt our models in ways that work for them.  

By sharing our experiences in the article, we aim to inspire and equip others to roll-out similar quality improvement initiatives that will drive long-standing change in chronic disease management.  

Download the article: Practical strategies for achieving system change in the US: lessons and insights from the CONQUEST quality improvement program is out now, in Primary Health Care Research & Development.  

CONQUEST is co-funded by Optimum Patient Care Global Limited and AstraZeneca.