Helping Patients with COPD Transition from Hospital to Home—The BREATHE Study

Aboumatar, Hanan; Naqibuddin, Mohammad; Chung, Suna; Chaudhry, Harman; Kim, Samuel; Saunders, Jamia; Bone, Lee R.; Gürses, Ayşe P.; Knowlton, Amy R.; Pronovost, Peter J.; Putcha, Nirupama; Rańd, Cynthia S.; Roter, Debra; Sylvester, Carol; Thompson, Carol B.; Wolff, Jennifer L.; Hibbard, Judith H.; Wise, Robert A.

doi:10.25302/04.2020.ih.13047118

Cited by 2 publications

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“…The program aimed to improve quality of life and reduce acute care use among patients with COPD. 15 The study's primary hypothesis was that compared with participants who received usual transitional care, participants randomized to receive this program would have a lower number of COPD-related acute care events and better HRQOL at 6 months after hospital discharge. 15…”

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confidence: 99%

Effect of a Program Combining Transitional Care and Long-term Self-management Support on Outcomes of Hospitalized Patients With Chronic Obstructive Pulmonary Disease

Aboumatar

Naqibuddin

Chung

et al. 2018

JAMA

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IMPORTANCE Patients hospitalized for chronic obstructive pulmonary disease (COPD) exacerbations have high rehospitalization rates and reduced quality of life.OBJECTIVE To evaluate a hospital-initiated program that combined transition and long-term self-management support for patients hospitalized due to COPD and their family caregivers. DESIGN, SETTING, AND PARTICIPANTSThis single-site randomized clinical trial was conducted in Baltimore, Maryland, with 240 participants. Participants were patients hospitalized due to COPD, randomized to intervention or usual care, and followed up for 6 months after hospital discharge. Enrollment occurred from March 2015 to May 2016; follow-up ended in December 2016. INTERVENTIONSThe intervention (n = 120) was a comprehensive 3-month program to help patients and their family caregivers with long-term self-management of COPD. It was delivered by COPD nurses (nurses with special training on supporting patients with COPD using standardized tools). Usual care (n = 120) included transition support for 30 days after discharge to ensure adherence to discharge plan and connection to outpatient care. MAIN OUTCOMES AND MEASURESThe primary outcome was number of COPD-related acute care events (hospitalizations and emergency department visits) per participant at 6 months. The co-primary outcome was change in participants' health-related quality of life measured by the St George's Respiratory Questionnaire (SGRQ) at 6 months after discharge (score, 0 [best] to 100 [worst]; 4-point difference is clinically meaningful). RESULTS Among 240 patients who were randomized (mean [SD] age, 64.9 [9.8] years; females, 61.7%), 203 (85%) completed the study. The mean (SD) baseline SGRQ score was 63.1 (19.9) in the intervention group and 62.6 (19.3) in the usual care group. The mean number of COPD-related acute care events per participant at 6 months was 0.72 (95% CI, 0.45-0.97) in the intervention group vs 1.40 (95% CI, 1.01-1.79) in the usual care group (difference, 0.68 [95% CI, 0.22 to 1.15]; P = .004). The mean change in participants' SGRQ total score at 6 months was −1.53 in the intervention and +5.44 in the usual care group (adjusted difference, −6.69 [95% CI, −12.97 to −0.40]; P = .04). During the study period, there were 15 deaths (intervention: 7; usual care: 8) and 337 hospitalizations (intervention: 135; usual care: 202). CONCLUSIONS AND RELEVANCEIn a single-site randomized clinical trial of patients hospitalized due to COPD, a 3-month program that combined transition and long-term self-management support resulted in significantly fewer COPD-related hospitalizations and emergency department visits and better health-related quality of life at 6 months after discharge. Further research is needed to evaluate this intervention in other settings.

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confidence: 99%

Effect of a Program Combining Transitional Care and Long-term Self-management Support on Outcomes of Hospitalized Patients With Chronic Obstructive Pulmonary Disease

Aboumatar

Naqibuddin

Chung

et al. 2018

JAMA

View full text Add to dashboard Cite

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“…The study intervention was co-developed with patients who have COPD, caregivers, and other stakeholders, with a focus on improving hospitalized patients' HRQOL and reducing their future need for seeking emergency care. 15,16 It included 3 components deemed necessary and complementary to achieving study goals 15 : 1. Transition support to try to ensure that patients and caregivers were prepared for discharge and understood the postdischarge plan of care.…”

Section: Intervention Groupmentioning

confidence: 99%

“…The program followed a patient-centered partnership approach and was delivered during a series of sessions held at the hospital and after discharge via home visit or telephone. 15 Comparison Group Participants in the comparison group received the usual transitional care provided at the study site. This included assigning a general transition coach to follow up the patient for 30 days after discharge, focusing on adherence to the discharge plan, and connecting to outpatient care.…”

Section: Intervention Groupmentioning

confidence: 99%

“…13,[19][20][21] The estimated sample size was 120 per group. 15 Unadjusted analyses of the treatment effect under intention to treat were performed using negative binomial regression for the cumulative count of events, and linear regression for change in SGRQ total and domain scores. Additional analyses were conducted, adjusting for baseline SGRQ and unit for change in SGRQ scores and predictors of hospitalization (age, home oxygen use, and hospitalization within past year) and unit for acute care event counts.…”

Section: Statistical Analysesmentioning

confidence: 99%

“…Main analyses were prespecified. 15 Statistical significance was considered for P < .05 (2-sided). No adjustment for multiple comparisons was performed, and therefore all analyses of secondary and other supplementary outcomes should be considered exploratory.…”

Section: Statistical Analysesmentioning

confidence: 99%

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Effect of a Hospital-Initiated Program Combining Transitional Care and Long-term Self-management Support on Outcomes of Patients Hospitalized With Chronic Obstructive Pulmonary Disease

Aboumatar

Naqibuddin

Chung

et al. 2019

JAMA

103

View full text Add to dashboard Cite

IMPORTANCEPatients hospitalized for chronic obstructive pulmonary disease (COPD) exacerbations have high rehospitalization rates and reduced quality of life.OBJECTIVE To evaluate whether a hospital-initiated program that combined transition and long-term self-management support for patients hospitalized due to COPD and their family caregivers can improve outcomes.DESIGN, SETTING, AND PARTICIPANTS Single-site randomized clinical trial conducted in Baltimore, Maryland, with 240 participants. Participants were patients hospitalized due to COPD, randomized to intervention or usual care, and followed up for 6 months after hospital discharge. Enrollment occurred from March 2015 to May 2016; follow-up ended in December 2016. INTERVENTIONSThe intervention (n = 120) involved a comprehensive 3-month program to help patients and their family caregivers with long-term self-management of COPD. It was delivered by nurses with special training on supporting patients with COPD using standardized tools. Usual care (n = 120) included transition support for 30 days after discharge to ensure adherence to discharge plan and connection to outpatient care. MAIN OUTCOMES AND MEASURESThe primary outcome was number of COPD-related acute care events (hospitalizations and emergency department visits) per participant at 6 months. The co-primary outcome was change in participants' health-related quality of life measured by the St George's Respiratory Questionnaire (SGRQ) at 6 months after discharge (score, 0 [best] to 100 [worst]; 4-point difference is clinically meaningful). RESULTS Among 240 patients who were randomized (mean [SD] age, 64.9 [9.8] years; 61.7% women), 203 (85%) completed the study. The mean (SD) baseline SGRQ score was 62.3 (18.8) in the intervention group and 63.6 (17.4) in the usual care group. The mean number of COPD-related acute care events per participant at 6 months was 1.40 (95% CI, 1.01-1.79) in the intervention group vs 0.72 (95% CI, 0.45-0.97) in the usual care group (difference, 0.68 [95% CI, 0.22-1.15]; P = .004). The mean change in participants' SGRQ total score at 6 months was 2.81 in the intervention group and −2.69 in the usual care group (adjusted difference, 5.18 [95% CI, −2.15 to 12.51]; P = .11). During the study period, there were 15 deaths (intervention: 8; usual care: 7) and 339 hospitalizations (intervention: 202; usual care: 137). CONCLUSIONS AND RELEVANCEIn a single-site randomized clinical trial of patients hospitalized due to COPD, a 3-month program that combined transition and long-term self-management support resulted in significantly greater COPD-related hospitalizations and emergency department visits, without improvement in quality of life. Further research is needed to determine reasons for this unanticipated finding.

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Helping Patients with COPD Transition from Hospital to Home—The BREATHE Study

Cited by 2 publications

References 0 publications

Effect of a Program Combining Transitional Care and Long-term Self-management Support on Outcomes of Hospitalized Patients With Chronic Obstructive Pulmonary Disease

Effect of a Program Combining Transitional Care and Long-term Self-management Support on Outcomes of Hospitalized Patients With Chronic Obstructive Pulmonary Disease

Effect of a Hospital-Initiated Program Combining Transitional Care and Long-term Self-management Support on Outcomes of Patients Hospitalized With Chronic Obstructive Pulmonary Disease

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