Respiratory Care Quality Improvement Project

North Country Hospital Quality Improvement

This project was initiated by Respiratory Care Services to improve outcome measurement for respiratory care patients and to meet criteria for accreditation from a nationally recognized accreditation agency for pulmonary rehabilitation.

Initiated in 2004 through 2005.

Problem Statement

An opportunity was identified to increase measurement of treatment outcomes for pulmonary health conditions. The patients targeted are those with moderate to severe lung disease.

Project Goals

Develop a strategy for regular and ongoing outcome measurement in respiratory care patients with moderate to severe lung disease in order to document improvement or change in:

activities of daily living
physical endurance
psychological behavior


Processes and procedures were instituted to improve documentation of above parameters in patients with moderate or severe lung disease. Documentation standards adopted are those utilized by the American Association of Cardiovascular and Pulmonary Rehabilitation. Following is a sample of these requirements:

Individual staff records such as renewal of certifications and licenses
Annual performance evaluations of staff including objectives
Summaries of training programs and other educational meetings
Personnel orientation with skills competencies documented
Proper facilities and equipment
Accurate and complete medical records
Plans for medical emergencies
Outcome assessments
Written individualized plan of care and projected outcomes/ goals developed for each patient
Interventions addressing exercise, education and behavioral components
Evaluation / discharge / follow-up

Baselines were established for a sample of nine patients measuring clinical, behavioral and qualify of life components. These patients were participants in North Country's Pulmonary Rehabilitation and Conditioning Service from September 1st, 2004 through February 14th, 2005. Measurements obtained pre-program and post-program were used to determine improvement or change in the three components.


Several clinical measures are utilized in the program:

All patients are monitored weekly for weight changes with goals being set for those who desire weight loss.
All patients participate in pre- and post-cardiopulmonary stress tests supervised by North Country's pulmonologist in conjunction with respiratory care staff.
All patients complete six-minute-walk evaluations before, during and upon completing the pulmonary rehabilitation program.

The behavioral measure used was Depression, Anxiety, Stress Score (DASS). This measure has since been changed to M.I.N.I, H.A.D.S., and Beck scales.

The measurement for quality of life is shortness of breath. Patients complete a questionnaire asking them to place a quantitative value of their shortness of breath relative to their functional activities of daily living.

Clinical, Behavior, Quality of Life Outcomes


Clinical - 6 minute walk
Behavioral - DASS
Quality of Life - Shortness of breath


Clinical - 9/04 - 2/05
Behavioral - 9/04 - 2/05
Quality of Life - 9/04 - 2/05

Sample Size

Clinical - 9
Behavioral - 9
Quality of Life - 9

Pre Program Score

Clinical - 580 ft
Behavioral - 22.7
Quality of Life - 24

Post Program Score

Clinical - 1053 ft
Behavioral - 14.2
Quality of Life - 21

Percent Change

Clinical - +81%
Behavioral - -37%
Quality of Life - -12.5%

The results illustrated in the table above, based on a sample size of 9 patients, show that:

• Patients were able to walk 81% further after their participation in the program when tested by the six-minute walk
• Patient perception scores for depression, anxiety, and stress decreased by 37% indicating psychological / behavioral health improvement.
• Patients' experience of shortness of breath decreased by 12.5%.

For more information, contact:

David Ingram, RRT
Manager of Respiratory Care Services
North Country Hospital
189 Prouty Drive
Newport, VT 05855
Tel: 802.334.3574