Table 1.

Barriers to optimal care (breakout sessions, Second Chronic Obstructive Pulmonary Disease Summit)

Transitions	Finances	Tools/Resources Needed
• Poor communication	• Inadequate reimbursements for time-intensive, proper transitional care	• Limited empirical evidence
• Ineffective discharge guidance	• Affordability of prescribed treatments and follow-up	• Lack of compliance with existing guidelines
• Lack of effective follow-up	• Incentives not aligned across the system	• Ineffective use of EHR
• Limited efforts to engage patients and family	• Recognition of nonmedical barriers & availability of solutions	• Diagnostic tool limitations/under and over diagnosis
• Patient not being placed at center of care	• Policies that limit access to educators, respiratory therapists and others outside the hospital	• Inadequate monitoring
• Fragmentation of system/differences in where individual seeks care	• Insufficient time for meaningful physician/patient engagement	• Access and monitoring for issues related to oxygen
		• Access and referral to pulmonary rehabilitation limited
		• Use of ER as a treatment center
		• Insufficient physician and patient education
		• Lack of dissemination of existing tools

Definition of abbreviations: EHR = electronic health record; ER = emergency room.

Data from Reference 51.