Research Summary

Embedding a COPD Care Pathway in the EHR Improves Referral Rates, Discharges to Home

Key Highlights

  • Use of an EHR-embedded chronic obstructive pulmonary disease care pathway was associated with increased pulmonary rehabilitation referrals (8.5% vs 1.6%).
  • Pathway use was linked to higher rates of discharge to home (87.3% vs 74.7%).
  • Admissions with pathway use had a shorter mean hospital stay (5.4 vs 7.1 days) and lower standardized hospitalization costs ($5756 vs $8781).
  • Although 30-day readmissions were numerically lower with pathway use, this difference was not statistically significant.

In a retrospective cohort study that evaluated the impact of embedding a chronic obstructive pulmonary disease care pathway (COPD CP) into the electronic health record (EHR) across seven hospitals within the Yale-New Haven Health System, researchers found that pathway use was associated with a more than five-fold increase in pulmonary rehabilitation (PR) referrals, nearly doubled odds of discharge to home, a reduction in mean length of stay, and lower standardized costs.

Despite the availability of evidence-based recommendations, hospital practice often diverges from best practice, with low referral rates to PR and inconsistent discharge planning. Previous strategies, such as care bundles and navigators, have produced variable benefits and are resource intensive. To address these gaps, investigators evaluated whether embedding a real-time COPD CP within the EHR could enhance adherence to best practices across a large health care system.

In their retrospective cohort study, Nancy Kim, MD, PhD, and colleagues analyzed all adult hospitalizations across the Yale-New Haven Health System from June 1, 2021, to May 30, 2022, for a primary discharge diagnosis of COPD exacerbation or acute respiratory failure with secondary COPD. The COPD CP was implemented system-wide in May 2021 and consisted of two components: (1) admission-focused guidance for diagnosis confirmation, specialty consults, and palliative care, and (2) a subsequent day module emphasizing patient education, discharge planning, and referrals for PR and tobacco cessation. The pathway was integrated into the EHR using AgileMD software, allowing clinicians to order, document, and access decision support at the point of care.

Among 766 patients contributing 971 hospitalizations, the CP was used in 142 admissions (14.6%). Patients in the pathway group did not differ significantly from nonusers in demographics, comorbidities, or smoking status. Pathway use was strongly associated with improved process measures and outcomes. In multivariable analysis, CP utilization increased odds of PR referral more than five-fold (odds ratio [OR] 5.76; 95% CI, 2.47–13.4) and nearly doubled odds of discharge to home (OR 1.96; 95% CI, 1.14–3.39). Pathway use was also associated with lower mean length of stay (5.4 vs 7.1 days) and lower standardized costs ($5756 vs $8781). Although 30-day readmissions were lower (16.2% vs 22.0%), this did not reach statistical significance.

Kim and colleagues noted several study limitations, including the low rate of pathway adoption (14.6%), the inability to determine which pathway component drove outcomes, and the reliance on surrogate measures (eg, vitamin D orders) to confirm active pathway use. Generalizability to other health systems may also be limited, given variability in resources and workflow integration.

Still, Kim and colleagues concluded that developing and applying an inpatient COPD CP is realistic and achievable.

“Implementation of an inpatient COPD CP is feasible, and despite a low utilization rate by health care professionals, is associated with improvements in referrals to PR at time of discharge and increased discharges to home,” the authors concluded. “CPs provide a practical vehicle to standardize evidence-based care across a large, complex health care system and ensure that all providers always have access to the most expert knowledge available without the need for additional human resources.”

Reference
Kim N, Teng W, Akande O, Rhodes D, Rochester CL. Impact of an inpatient COPD care pathway on hospital care process and outcome metrics. Chronic Obstr Pulm Dis. 2025;12(4):304-316. doi:10.15326/jcopdf.2024.0585