COPD is the fourth leading cause of morbidity and mortality
in the United States,11 and the State of Maine has one of
the highest COPD mortality rates in the nation.12 Proportionally,
far more people are hospitalized for COPD each
year in the central and northeastern regions of Maine than in
the southern region.13 A 2001 community health assessment
data provided evidence that high hospital inpatient rates for
COPD and inadequate treatment resources existed across the
northern, central, and eastern regions of Maine.14 In response,
Eastern Maine Hospital System’s (EMHS) Institute of
Medical Improvement (IMI) and its partners engaged in a
3-year project to determine whether COPD best practices
including the GOLD guidelines could be successfully integrated
into the routine care practices of providers in rural
Maine. Included in the partnership were the IMI, the University
of New England Center for Health Policy, Planning,
and Research, the Maine Network for Health, and 18 primary
care clinical practices located in these regions.