The E-Coach technology-assisted care transition system: a pragmatic randomized trial

Abstract

Care transitions from the hospital to home remain a vulnerable time for many patients, especially for those with heart failure (CHF) and chronic obstructive pulmonary disease (COPD). Despite regular use in chronic disease management, it remains unclear how technology can best support patients during their transition from the hospital. We sought to evaluate the impact of a technology-supported care transition support program on hospitalizations, days out of the community and mortality. Using a pragmatic randomized trial, we enrolled patients (511 enrolled, 478 analyzed) hospitalized with CHF/COPD to "E-Coach," an intervention with conditionspecific customization and in-hospital and postdischarge support by a care transition nurse (CTN), interactive voice response post-discharge calls, and CTN follow-up versus usual post-discharge care (UC). The primary outcome was 30-day rehospitalization. Secondary outcomes included (1) rehospitalization and death and (2) days in the hospital and out of the community. ECoach and UC groups were similar at baseline except for gender imbalance (p = 0.02). After adjustment for gender, our primary outcome, 30-day rehospitalization rates did not differ between the E-Coach and UC groups (15.0 vs. 16.3 %, adjusted hazard ratio [95 % confidence interval]: 0.94 [0.60, 1.49]). However, in the COPD subgroup, ECoach was associated with significantly fewer days in the hospital (0.5 vs.

Life‐Space Assessment Predicts Hospital Readmission in Home‐Limited Adults

“…If access to their cardiologist is impeded, the complexity of their condition and the fact that medication management decisions often require provider involvement may drive people to urgent care settings . Because the E‐Coach intervention did not involve calling the participants’ providers, it may have led to more hospital readmissions if the individuals’ conditions required provider interaction . In this study, randomization group was adjusted for in the logistic regression model.…”

“…[17][18][19] Because the E-Coach intervention did not involve calling the participants' providers, it may have led to more hospital readmissions if the individuals' conditions required provider interaction. 20 In this study, randomization group was adjusted for in the logistic regression model. Further research is needed to better understand the association between LSA score and hospital readmission in other populations.…”

Tele-nursing in patients with chronic illness: a systematic review

“…Un 56% (n=19) de los estudios seleccionados 10,14,16,18,20,[25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] identificaron el soporte virtual como una de las principales características de la tele-enfermería. Se caracteriza principalmente por el uso de páginas web o videos con fines educativos 25,27 , incluyendo formularios auto-evaluativos, enlaces a páginas web de interés y cursos de formación para fomentar un mayor automanejo y adaptación del paciente con el proceso crónico 30 .…”

“…Nueve de los estudios seleccionados 10,17,28,35,36,[40][41][42][43] (26%) presentaron el seguimiento telefónico como otra de las características clave de la tele-enfermería, cuyo objetivo es llevar a cabo una atención individualizada y específica de la conviven-cia del paciente con la enfermedad 36,38 . El seguimiento telefónico consiste en la planificación semanal de llamadas a través de las cuales el profesional sociosanitario fomenta una relación terapéutica 41 con el paciente donde este es el foco de atención, solventando las dudas referentes a su día a día con la enfermedad crónica 16,28,43 .…”

Formative Evaluation to Determine Facilitators and Barriers to Nurse-driven Implementation: Designing an Inpatient mHealth Intervention to Support Smoking Cessation

“…As insufficient time and a lack of administrative resources are known to be the largest barriers to nurse practice change in the clinical setting, and specifically to tobacco cessation counseling by nurses [23][24], ease of introduction and patient sign-up was valued in the creation of TIPS. Commonly, nurseintroduced technologies for patients are institutionally owned devices loaned to patients for one-time use, and are either for educational or assessment purposes [25][26], or for symptom monitoring post-hospitalization with use over time [27]. As far as the authors are aware, nurses introducing the use of a technology on the patient's own device for repeated exposure to content and to increase motivation for behavior change has not been examined.…”