A Strategic Plan to Address COPD in Nevada: A Three-Year Plan

A Strategic Plan to Address COPD in Nevada: A Three-Year Plan 1

A Strategic Plan to

Address COPD in Nevada:

A Three-Year Plan


2. Letter from American Lung Association

3. Acknowledgements

4. Executive Summary

5. Introduction

10. Data and Surveillance

11. Awareness and Prevention

12. Reduce Readmission Rates

14. Community Coordination and Advocacy

15. References

Table of Contents


LETTER FROM

American Lung Association in Nevada

Dear Nevadans,

Serving Nevada since 1910, American Lung Association in Nevada is the state’s oldest

health non-profit organization and one of the most trusted. Over the past 100 years

the American Lung Association in Nevada has worked toward our mission of

eradicating lung disease through education, outreach, advocacy and research, while

lessoning the burden of asthma, COPD, lung cancer and tobacco use. American Lung

Association in Nevada is eager to share with you A Strategic Plan to Address COPD in

Nevada. Currently, Chronic Obstructive Pulmonary Disease is the third leading cause

of death in Nevada and continues to burden more lives each year. A Strategic Plan to

Address COPD in Nevada: A Three Year Plan presents goals, objectives and strategies

to reduce COPD prevalence in Nevada.

In 2015, the American Lung Association in Nevada was awarded a subcontract from

the COPD Learn More Breathe Better (LMBB) program. A Strategic Plan to Address

COPD in Nevada: A Three Year Plan is made possible by grant funding provided

through the National Heart, Lung and Blood Institute (NHLBI) and administered by

Porter Novelli Public Services.

Nevada is the seventh largest state and represents major metropolitan area, along

with rural and frontier locations. In order to understand the opportunities for both

healthcare providers and patients throughout the state we gathered experts together

for stakeholder meetings. These meetings paved the direction that would direct our

way to a sustainable and effective plan for the state of Nevada. The dedication and

perseverance of these stakeholders provided us the inspiration to create a plan with

intent to make a positive impact for the 7.2% of Nevadans with COPD. With the

collaboration of hard work and expertise among stakeholders, this plan exhibits true

passion for improvement of lives affected by COPD in Nevada.

It has been a great pleasure to collaborate with the community and those stakeholders

who brought their expertise to this plan. We hope you will join us and look forward to

the impact we can make in Nevada by working together.

Sincerely,

Frankie Vigil

Executive Director


The Strategic Plan to Address COPD in Nevada: A Three-Year Plan is a result of a dedicated

collaboration between American Lung Association in Nevada and twenty-six stakeholders who brought

their expertise and ideas to the development of this plan. American Lung Association in Nevada would

like to express our sincere gratitude to all the stakeholders and organizations that put in the time and

effort to create this strategic plan to address COPD in Nevada.

Special thanks to

Oluyemisi Adedotun RN, MSN, APRN, DNPc,

ATOP Clinical Care Practitioner, Health Insight

Betsy Aiello MBA, OTR/L, Deputy

Administrator, Division of Health Care Financing

and Policy

Amiee Barnes BSRT, RRT, Director of Clinical

Education, Pima Medical Institute

Karen L. Bowers Alpha-1 Support Group Co-

leader

Marissa Brown, MHA, BSN, RN Workforce and

Clinical Services Director, Nevada Hospital

Association

Dan Clack RCP

Kathy Cocking MSN, RN, Nurse Manager

Carson Valley Medical Center

Shannon Cridebring RCP, Manager of

Respiratory Care Services and EKG, Carson

Valley Medical Center

Margaret Curley, BSN, RN, Executive Director,

Nevada Nurses Association

Reka Danko M.D., Chief Medical Officer,

Northern Nevada HOPES

Richard Davis CTTS, Adult Lung Health

Program Manager, American Lung Association

in Nevada

Rebecca Edgeworth MD, Medical Director,

Volunteers in Medicine of Southern Nevada

Barbara Kaliney RN, BSN, HACP, Nevada

Service Area Director, Quality and Risk

Management Services, Patient Safety Officer

Trang (Susan) Nguyen, PharmD, Assistant

Professor of Pharmacy Practice, Roseman

University of Health Sciences, Clinical

Pharmacist, Volunteers in Medicine of Southern

Nevada

Samantha Lafata RRT, Director of

Cardiopulmonary Services, Centennial Hills

Hospital Medical Center

Randy Loo RT, Supervisor of Respiratory Care

Amanda Magrini MD

Monica Morales MPA, Section Manager,

Chronic Disease Prevention and Health

Promotion, Division of Public and Behavioral

Health, Bureau of Child, Family and Community

Wellness

John Packham PhD, Director of Health Policy

Research, Office of Statewide Initiatives,

University of Nevada School of Medicine

Robert Pretzlaff M.D., MBA, FAAP, Chief

Medical Officer, Dignity Health, St. Rose

Dominican

Gus Straub Alpha-1 Advocate & Group Leader

Las Vegas, NV

Nancy Seck RN, BSN, MPH, CPHQ

Tammy Sutton, Resource Coordinator

SSES/SSMS, Community Health Advocate

(CHA) Stand Tall SSHS, Healthy Communities

Coalition

George Wenner MS, RN, CPHO, CPHRM,

Director of Quality Management, Spring Valley

Hospital, Las Vegas NV

Acknowledgments


The Strategic Plan to Address COPD in Nevada: A Three-Year Plan is the outcome from a partnership

between the American Lung Association in Nevada and a dedicated group of twenty-six stakeholders

around the state. The Strategic Plan to Address COPD in Nevada is a three-year plan funded through the

National Heart, Lung, Blood Institute. In May 2015, American Lung Association was awarded a

subcontract award from the COPD Learn More Breathe Better and was made possible by Porter Novelli

Public Services.

This plan intends to make a positive impact for all those who are affected by COPD in Nevada by

addressing concerns and creating new goal outcomes. The overall goal for the Strategic Plan to Address

COPD in Nevada: A Three-Year Plan is to address COPD concerns and empower COPD patients. This

plan will focus on goal development focused to create a better quality of life for COPD patients and

decrease rising rates of COPD in Nevada. This plan will bring awareness to COPD through more

sustainable prevention and educational programs that will give power to the community and COPD

patients.

Executive Summary


Chronic Obstructive Pulmonary Disease is a progressive disease that burdens millions of people every

year. Chronic Obstructive Pulmonary Disease is a progressive condition and will continue to get worse

overtime. This progressive disease makes it hard to breathe and diminishes the quality of life for each

person who has been diagnosed. In the United States, Chronic Obstructive Pulmonary Disease is the

third leading cause of death.1 In Nevada, Chronic Obstructive Pulmonary Disease is the third leading

cause of death and these numbers are growing.2 Today, more than 11 million people are known to have

COPD and an estimated 24 million people are living with COPD, unaware that they even have COPD.

What is COPD?

Chronic Obstructive Pulmonary Disease,

commonly known as COPD, is a type of lung

disease that makes breathing more difficult. This

progressive disease is caused by an obstruction

to airflow making breathing more difficult and it

can lead to breathing related problems. COPD is

a combination two conditions called emphysema

and chronic bronchitis.

To better understand these conditions, let’s first

look at the anatomy of the lungs. When a breath

is taken, air fills the windpipe traveling down into

the bronchial tubes inside the lungs. The

bronchial tubes branch off into thousands of

smaller tubes called the bronchioles. On the end

of each of these bronchioles are alveoli, also

known as air sacs. These air sacs are

responsible for air exchange.

Emphysema is caused by damage to the alveoli

(air sacs) and this results in more difficult

breathing. This difficulty in breathing caused by

emphysema is from the lack of air exchange

between oxygen and carbon dioxide. Breathing

out to bring in new air is compromised with a

person suffering from emphysema.

Chronic bronchitis is a long-term inflammation of

the lining of the airways, or bronchial tubes. Due

to this inflammation of the airways, less air is

able to travel through them, making breathing

more difficult. Someone with chronic bronchitis

will cough up heavy mucus/phlegm, which also

contributes to difficulty in breathing.3 There is no

cure for COPD and it will progressively get

worse as time goes by. However, there are

steps that a person can take to help manage

their COPD. and have their disease under

control.

Introduction

Figure 1


Causes

The causes of COPD are due to long term

exposure to irritants that affect the lungs and its

functional anatomy. For Americans, the number

one cause of COPD is a result of cigarette

smoke. This can include smoking tobacco from

a pipe, cigar or other forms of cigarette smoke.5

There are other irritants that also affect the

lungs and increase a person’s chance of

developing COPD. These irritants include

secondhand smoke, outdoor pollutants and

workplace chemicals/pollutants.

A rare genetic condition can also be a factor for

a person developing COPD. Alpha-1 Antitrypsin

(AAT) is genetically inherited and is produced in

the liver. Alpha-1 deficiency is when the body

doesn’t make enough of this normal protein to

protect the lungs as it should and this leads to

lung disease to start. Like many people suffering

from COPD, these individuals might not be

aware that they have this deficiency and that it is

causing their breathing problems. By conducting

a blood test, the health care providers will be

able to rule out or diagnose this potential

problem.

Symptoms

COPD is a progressive disease that can cause

little to no symptoms in the early stages. If

symptoms appear they are mild and can go

unnoticed. As the disease progresses, the

symptoms begin to get more severe and

interfere with the person’s daily activities.

Some examples of symptoms experienced by

COPD patients’ include5:

Coughing or “smokers cough”

Shortness of breath, can be during

activities of everyday living

Wheezing

Mucus production during coughing

Chest tightness

Frequent respiratory infections

COPD

Causes

Cigarate Smoke

Workplace Chemicals/

Fumes

Genetic (AAT)

Air Polution

of Nevada adults

(ages 18+)

currently smoke

cigarettes


Diagnosis and Treatment

Spirometry is considered to be the gold standard

for determining if a patient has COPD. It a

simple, quick and efficient way that will measure

how well a person’s lungs function. It is a

noninvasive and painless test that can be

conducted by a physician. Using a spirometer

device that measures the amount of air and the

speed of the air is blown out of the person’s

lungs, the physician can determine if there are

any signs of COPD. Spirometry can determine if

a person has COPD even before the symptoms

begin or progress3.

It is recommended that those who have been

exposed to tobacco, pollutants and are over the

age of 40 to be tested if they are experiencing

symptoms of COPD. For those individuals

under the age of 40, who have COPD, it is

encouraged to be tested for AAT deficiency

through a blood test.

Being that there is no cure for COPD, making

lifestyle changes and undergoing treatments can

help a person improve their quality of life. The

most important lifestyle change that a person

can undergo if they have COPD is to quit

smoking. Smoking cessation can slow down the

progression of the disease. Another important

lifestyle change is to eliminate one’s exposure to

environmental pollutants, such as gases, fumes

etc.

There are other treatment options that are

available to help with the symptoms associated

with COPD. Medications can be prescribed or

recommended for patients to help with their

symptoms. Inhalers are medications that are

considered a type of treatment option. Oxygen

therapy is a type of treatment that is intended for

individuals with COPD who have low

bloodstream oxygenation. Pulmonary

rehabilitation is focused to reduce one’s

symptoms and increase the amount of activity a

person can do. It is a program that is customized

for each person and their abilities. This type of

rehabilitation is meant to increase endurance so

a person with COPD can be active in their daily

activities.

Burden of COPD in Nevada

Nevada is the seventh largest state in the United

States with an estimated population of 2.8

million.

In 2011, 67.5% of COPD patients in

Nevada reported that shortness of breath affected their quality

of life

Figure 2


Nevada has a unique factor that sets them apart

from many other states. In Nevada, the

populations are sparsely scattered, creating a

larger number of rural counties and frontiers.

Nevada is amongst the highest mortality rates

related to COPD, like many other mountain west

states in the U.S. In Nevada COPD is the third

leading cause of death and has an age-adjusted

mortality rate between 43.4 – 48.4 deaths per

100,000 people.8

Prevalence

In 2011, the prevalence by demographics in the

states of Nevada shows that 7% of Nevadans

were diagnosed with COPD.6 The prevalence of

COPD in rural and frontier counties shows a

larger percentage of COPD in comparison to

more urbanized counties. Washoe County (6%)

and Clark County (7%) show a lower percentage

of Nevadans with COPD in comparison to other

rural/frontier counties (10%).6

Nevada has the 9th highest smoking rate in the

U.S with an estimated current cigarette smoking

percentage statewide rate at 21.3% of adults.

7With a high rate of smoking and an increasing

population of older adults we expect that the

rates for COPD in Nevada will continue to

increase every year.

Age and Gender

Based on recent studies determined by the

CDC, the most at risk populations for COPD are

those who are age 45 and older.9 If you are a

women, your chances of developing COPD are

greater than men. According to the American

Lung Association woman’s rates of death from

COPD and living with COPD for most of their

lifetime are increasing sharply. \\

Figure 4 Figure 3

Figure 5

0

2

4

6

8

10

12

14

16

18-44 45-54 55-64 65-74 75 orolder

Pe

rce

nt

PERCENT OF NEVADA ADULTS

WITH COPD

Percent of Nevada Adults with COPD

Age Group


Goal: To improve the collection and reporting of COPD- related public health data for the state of

Nevada.

Objective: By the end of the first year of implementation, a central location of COPD-related public health

data and resources will be established to ensure there is better distribution, utilization and accessibility of

information for the state of Nevada.

Strategies:

1. Conduct research to identify all current COPD-related public health data online and in-print

resources.

2. Contact a representative from all sources online and in print that currently exist that assist the

public and patients with COPD information.

3. Collaborate with all online resources to create (or enhance an already existing site) a COPD

online database that is updated annually with input from all representatives.

4. Collaborate with all Nevada hospitals, clinics, health department representatives who report

current public health data and collaborate together to improve/establish a surveillance system

that will accurately track COPD readmission, mortality and morbidity in Nevada on a central

online location

Data and Surveillance


Goal: Increase public awareness of COPD through education and prevention methods.

Objective: Improve and coordinate COPD awareness and prevention efforts through community

education and engagement in Nevada by the beginning of year two of implementation.

Strategies:

1. Partner with all current local and statewide tobacco education and prevention programs to

increase the success rate and sustainability of the programs currently in place.

2. Partner with all current local and statewide tobacco education and prevention programs to create

more sustainable and effective programs.

3. Partner with all current local and statewide tobacco control programs to support policy efforts

pertaining to the Clean Indoor Act, increasing tobacco tax, increasing the age of purchase and all

other tobacco related policies.

4. Collaborate with all Nevada school districts in an effort to voluntarily increase the amount of

tobacco prevention programs organized in each district.

5. Partner with 1-800-Quit-Now, a program of the Nevada Division of Public and Behavioral Health,

in directing current smokers to utilize current availability of smoking cessation materials

6. Provide smoking cessation materials to COPD patients who currently smoke and provide them

with information and referrals to smoking cessation programs currently available

7. Collaborate with the National COPD Awareness Month every year in November

Awareness and Prevention


Goal: Establish a sustainable post-discharge plan for all COPD patients in order to decrease the annual

readmission rates in Nevada for COPD.

Objective: At the end of the first year following implementation of the plan, there will be a 10% decrease

in the number of readmissions of patients with COPD overall in the state of Nevada.

Strategies:

1. Research all current admitting assessments conducted by health providers around Nevada

2. Create a standard assessment of questions for RTs/Physicians/RNs to each new COPD

patient that is admitted

3. Focus on having the provider determine where the patient can better manage their COPD

4. Create a mandatory, system-wide Action Plan that each COPD patient receives upon

discharge from a Nevada hospital

5. Provider will create a personalized Action Plan for each COPD patient

6. Partner with Community Health Workers and other volunteers in the community to be

involved in providing follow-up services to recently discharged COPD patients

7. Assign a volunteer/Community Health Worker to patients with multiple recurring health

problems

8. Connect patient with their primary care physician and set a follow-up appointment within two

weeks of discharge

9. Collaborate with local fire departments and paramedics to conduct in-home follow-ups with

recent discharged COPD patients

10. Set up mandatory follow-up call after 7 days from discharge date for all newly diagnosed

patients discharged from the hospital with COPD

11. Recruit volunteers and professionals in the community to create and maintain a COPD

support group/buddy system program

12. Offer and Enroll all COPD patients in a COPD support groups and/or buddy system

Reduce Readmission Rates


13. Ensure transportation with the help from community health workers to get patients to follow-

up appointments, support groups and the pharmacy for their medications


Goal: Increase community partnerships in urban, rural and frontier counties to ensure all COPD patients

have access to health providers and educational services.

Objective: By the end of the second year of plan implementation, Nevada will have successfully

expanded at least two successful healthcare services to all COPD patients in the state in order help these

patients better manage and treat their condition.

Strategies:

1. Research and partner with TeleMed services. Telemedicine is the use of medical information

from a specific site that is shared via electronic devices (smart-phone, two-way video, email,

etc.). This will enable health care providers to share medical information with their patients

without having the issue of distance. to expand this innovative healthcare service

2. Provide a TeleMed education service option to all COPD patients. These educational services

will allow patient and health care provider to communicate information and will eliminate lack of

access to care for those patients living in rural/frontier counties in Nevada

3. Contact local paramedic services (REMSA/EMS) and local firefighter groups in an effort to

expand, enhance and educate COPD patients in the form of in home care check-ins after

medical discharges/recent diagnosis

4. Create partnerships between local paramedic and firefighters for in home care follow ups and

check-ins with all

Goal: Increase communication amongst all levels of providers that interact with COPD patients in the

community.

Objective: Within the first year following implementation of the plan, Nevada will create a COPD Work

Group composed of medical professionals around the state that will collaborate together to find a strategy

for improving COPD patients’ quality of life.

Strategies:

1. Conduct research and outreach to contact a diverse group of Nevada medical professionals

willing to commit to being involved in a Work Group.

2. Create a meeting schedule based on determined frequency and set a location to host the COPD

Work Group

3. Develop focus areas to identify opportunities for Nevada to support COPD patients’ quality of life

4. Develop strategic methods to address opportunities to course correct challenges in the current

system and turn them into successes

Community Coordination and Advocacy


1. “What is COPD?”. NHLBI, NIH. U.S. Department of Health and Human Services, 31 July

2013. Web. 24 Sept. 2015.

2. CDC.gov. Web. 24 Sept. 2015.

<http://www.cdc.gov/nchs/pressroom/states/NV_2014.pdf>.

3. “Understanding COPD –American Lung Association.” American Lung Association. 2015.

Web. 24 Sept. 2015.

4. “What is COPD? COPD Symptoms & Risk Factors, COPD Definition.” What Is COPD?

COPD Symptoms & Risk Factors, COPD Definition. 2015. Web. 24 Sept. 2015.

5. “What Causes COPD?” –NHLBI, HIH. Web. 24 Sept. 2015.

6. “Office of Public Health Informatics and Epidemiology.” Nevada State Health Division.

Web. 5 Oct. 2015

7. “THE BURDEN OF TOBACCO IN NEVADA – 2012” 2012. Web. 24 Sept. 2015.

8. “Data and Statistics.” Centers for Disease Control and Prevention. Centers for Disease

Control and Prevention, 8 Dec. 2014. Web. 24 Sept. 2015.

9. “COPD among Adults in NEVADA.” Web. 24 Sept. 2015.

<http://www.cdc.gov/copd/maps/docs/pdf/NV_COPDFactSheet.pdf>.

10. Web. 24 Sept. 2015. <http://www.lung.org/assets/images/lung-disease-

thumbnails/copd/graphbig.png>.

Figure 1: “Air Purifiers for COPD & Smoke, Organsi Learning Center.” Air Purifiers for COPD &

Smoke, Organsi Learning Center. Web. 30 Sept. 2015.

Figure 2: “How to Use Incentive Spirometer Airlife Volumetric.” ActiveForever.com. Web. 30

Sept. 2015.

Figure 3: “COPD among Adults in NEVADA.” Web. 24 Sept. 2015.

<http://www.cdc.gov/copd/maps/docs/pdf/NV_COPDFactSheet.pdf>.

Figure 4: “Data and Statistics.” Centers for Disease Control and Prevention. Centers for

Disease Control and Prevention, 1 May 2014. Web. 30 Sept. 2015.

Figure 5: “Understanding COPD – American Lung Association.” American Lung Association.

Web. 30 Sept. 2015.

References

http://www.cdc.gov/nchs/pressroom/states/NV_2014.pdf

http://www.cdc.gov/copd/maps/docs/pdf/NV_COPDFactSheet.pdf

http://www.lung.org/assets/images/lung-disease-thumbnails/copd/graphbig.png

http://www.lung.org/assets/images/lung-disease-thumbnails/copd/graphbig.png

http://www.cdc.gov/copd/maps/docs/pdf/NV_COPDFactSheet.pdf

Documents

A Strategic Plan to Address COPD in Nevada: A Three-Year Plan