The impact of patient education and shared decision making on hospital readmissions for COPD

Abstract

PurposeEducation on the self-management of COPD has been shown to improve patients’ quality of life and reduce hospital admissions. This study aimed to assess the feasibility of a pilot, pragmatic COPD Chronic Care (CCC) education program led by registered respiratory therapists and determine the CCC’s impact on hospital readmissions, patient activation, and health status.Patients and methodsThis was a prospective, randomized, pilot study of inpatients with COPD admitted to a US community hospital between August 2014 and February 2016. In total, 308 patients were randomized 1:1 to receive standard care with or without the CCC program. Outcomes included the number of patients completing the program, frequency and time to first all-cause and COPD-related hospital readmissions, and changes in the Patient Activation Measure (PAM) and COPD Assessment Test (CAT).ResultsOverall, 37% (n=52) of patients in the CCC group and 29% (n=48) of patients in the control group remained in the study for 6 months and completed all follow-up phone calls. In total, 74% (n=105) of patients in the CCC group and 69% (n=115) of patients in the control group had at least one readmission (P=0.316). The time to first all-cause and COPD-related readmission appeared shorter for patients in the CCC group compared with the control group (mean [standard deviation]: 50.2 [54.5] vs 59.9 [63.1] days and 95.1 [80.2] vs 113.7 [82.4] days, respectively; both P=0.231). Patients experienced significant improvement from baseline in mean PAM (both groups) and CAT (CCC group) scores.ConclusionUtilizing respiratory therapists to lead a chronic care education program for COPD in a community hospital was feasible. Although CCC patients showed improvements in perceived symptom severity, they were readmitted sooner than control group patients. However, the program did not impact the frequency of hospital readmissions. A more comprehensive disease management program may be needed to improve outcomes.

Impacto de uma intervenção educacional de enfermagem em pacientes portadores de DPOC

“…O processo educativo do paciente e familiar durante a internação hospitalar ganhou destaque nos últimos tempos e tem apresentado resultados relevantes principalmente para doenças crônicas 31 . Vale destacar que a participação do enfermeiro neste processo é fundamental para se atingir os resultados esperados 32 .…”

<p>Assessment of COPD-Related Knowledge Among Internal Medicine Nurses: A Cross-Sectional Study</p>

“…In a longitudinal national register study comparing those not participating in education programs to those who did, the health-related quality of life (HRQoL) of non-participants deteriorated significantly 18. Collinsworth et al19 reported that the time to first all-cause and COPD-related readmission appeared shorter for patients receiving education. Dogan and Ovayolu et al20 found that the health education provided by nurses to COPD patients can significantly improve PaO 2 , PaCO 2 , FEV 1 and SaO 2 of patients in the education group.…”

Predicting and preventing hospital readmission for exacerbations of COPD

“…In contrast, although perceived health status was improved, patients who received education on self-management of COPD were readmitted sooner than those receiving standard care [121]. In another study, higher readmission rates were observed following the implementation of a 3-month programme which focused on transitional care and self-management support [122].…”