Reframing COPD: From Discharge to New Beginnings

Written by

Fei Gao

Studio Lead

---

I've been working with Dr. Press and her team from the University of Chicago on opportunities to incorporate human-centered design elements into COPD (Chronic Obstructive Pulmonary Disease) care for a few years. As we continue to build on the progress and momentum over the long haul, I can't help but share some of my personal reflections.

Meet them where they are with post-discharge phone calls

We were having conversations with patients living with COPD about the post-discharge phone calls they receive from hospitals. Overall, the patients felt that the calls they received over the years were not very helpful. They believed that the calls were made within a certain timeframe after discharge to avoid lawsuits or fulfill an insurance requirement by someone who did not know the patient or COPD as a condition.

To reduce readmission rates, hospitals often turn to these phone calls. The usual script involves asking patients if they have any questions and offering assistance. However, these calls do not provide much value to patients for two reasons. First, patients tend to overestimate their knowledge about COPD. Second, they often do not know what they do not know and are unsure what questions to ask. It is difficult to communicate with healthcare professionals without a high level of knowledge and confidence, especially for patients who are new to the condition.

One way to tackle this issue is to assess the patient's COPD knowledge with a standardized test that can be delivered over the phone or online. Once the baseline knowledge is established, targeted education can be provided. A term that a lot of health care professionals like to use nowadays is to meet patients where they are. It’s catchy to say, but hard to achieve. If we don’t know where our patients are in terms of their understanding of the condition they have, how could we ever meet them there?

Reframe: re-admission vs. re-orientation

One of my favorite things to do is to help clients reframe their thinking by really listening to the people they are trying to serve. This usually leads to new perspectives that open up new opportunities to better serve your customers.

During the conversation, we discussed the topics that should be covered during a post-discharge phone call. These topics include clarifying billing, setting up home care devices such as oxygen, teaching breathing techniques, reinforcing COPD knowledge, providing community resources, and identifying and addressing barriers to accessing care. There are many others, but one aspect was especially inspiring.

One patient used the term 'mourning my old life,' which really struck me. What we have been missing is this dimension where patients arrive at the realization that they may never be able to do what they love because of this condition. It could be hobbies like traveling, sports, or routines like walking to the grocery store every day. This is a huge transition for people. Patients with positive mindsets and good family and community support could come out of this period strong. They could rent scooters to get around with oxygen, carpool with friends to go to the opera, even get into new hobbies like golf. While others may not be as lucky or resourceful. Patients could slip into depression as they lose the few precious things they enjoy in life.

As hospitals focus on avoiding readmission, and checking off boxes on things they think could help them achieve that, what we as a society are ignoring is this vulnerable moment in a new COPD patient’s life, where they could lose hope and meaning in life. There are actually a lot we could do to help people in this moment. A combination of social work and occupational therapy based approaches could be leveraged to help patient prioritize and re-orient in their new life. What it takes is a reframe here. It's not about calling patients after discharge to check in, it's about supporting patients and their family through the mental and physical transition into a new lifestyle, a life now with COPD.