medwireNews: An intervention combining transitional care and self-management support after hospital discharge reduces the number of subsequent hospital visits and improves health-related quality of life among patients with chronic obstructive pulmonary disease (COPD), trial findings indicate.
As reported in JAMA, 240 patients who were hospitalised due to COPD were randomly assigned to receive the 3-month BREATHE intervention – a hospital-initiated programme that provided transitional support for patients and family caregivers after hospital discharge, as well as individualised self-management guidance and access to community programmes – or to receive usual transitional care for 30 days after discharge.
Participants who took part in the BREATHE programme, delivered by specialised COPD nurses over an average of 6.1 visits, had significantly fewer COPD-related hospital readmissions and emergency department visits in the 6 months after discharge than those in the control group, at an average of 0.72 versus 1.40 events per patient.
Moreover, patients in the intervention group experienced a 1.53-point improvement in St George’s Respiratory Questionnaire health-related quality of life score over the study period, whereas those in the control group experienced a worsening of 5.44 points, giving a significant between-group difference of 6.69 points after adjustment for baseline score and hospital enrolment unit.
Hanan Aboumatar (Johns Hopkins School of Medicine, Baltimore, Maryland, USA) and co-investigators report that there were 337 hospitalisations and three falls resulting in emergency care visits during follow-up, but “[n]o adverse events were attributed to the study intervention.”
Noting that previous studies have not demonstrated consistent benefits of discharge interventions and self-management programmes for COPD, the researchers believe that “several features” may have contributed to the success of the BREATHE intervention.
They suggest that starting self-management conversations during hospitalisation “may have increased patient engagement”, and that connecting patients with their COPD nurse whilst still in hospital “may have helped with continuity of care and relationship building”. The team also emphasises that “the program was individualized according to patient needs and priorities”, which allowed flexibility for patients and nurses.
Describing these findings as “encouraging”, the authors of an accompanying editorial say that “clinical and administrative leaders may wonder whether the intervention should be adopted in their hospitals.”
Seppo Rinne (Veterans Affairs, Bedford, Massachusetts, USA) and colleagues caution, however, that the trial was conducted at a single centre and included a high proportion of patients with a low level of income (≤US$ 20,000 [€ 17,743]; 63%) and education (<12th grade; approximately 40%), meaning the results may not be “generalizable to other patient populations and health care settings”.
And the editorialists conclude that “additional research is needed before adopting these findings into clinical practice.”
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