Explore the vast range of titles available.

Chronic obstructive pulmonary disease (COPD) affects more than 16 million US adults, many of whom experience high rates of acute care revisits (emergency department and hospital) after initial hospitalization. These frequent exacerbations, often due to failures in transitions of care (TOC), lead to lung function decline and premature mortality. While effective interventions exist to reduce readmissions, wide-scale implementation of COPD TOC programs remains limited. The National Institutes of Health-funded Reducing Respiratory Emergency Visits Using Implementation Science Interventions Tailored to Settings (REVISITS) study was designed to address this implementation gap by developing and implementing bundled COPD TOC programs across diverse US hospitals. This study aimed to conduct pre-implementation contextual assessments at US hospitals to guide the development of site-specific, evidence-based COPD TOC programs. We conducted pre-implementation contextual assessments using a novel semi-structured interview format that integrated the Consolidated Framework for Implementation Research (CFIR) with human-centered design approaches (ethnographic interviewing) to capture real-world experiences of COPD care across inpatient, outpatient, and home settings. We used a sequential explanatory mixed methods design in which pre-interview survey data completed by site leads informed and shaped the subsequent semi-structured interviews. Site leads, clinicians, organizational leaders, patients, and caregivers were interviewed. Interviews explored baseline COPD TOC practices, local resources, opportunities for improvement, as well as participant priorities from a menu of 12 evidence-based interventions (eg, pulmonary rehabilitation, patient navigation, and inhaler teaching). Rapid analysis methods identified intervention priorities across participant groups, along with perceived barriers and facilitators to implementation. Findings were shared with site leads to help guide their development of tailored COPD TOC programs. Among 194 participants from 21 sites (42 site leads, 29 organizational leaders, 105 clinicians, and 18 patients or caregivers), the highest priority interventions identified during interviews were post-emergency department follow-up visits, education (inhaler technique, disease management, and action plan), and pulmonary rehabilitation. Reported barriers included clinician-level challenges (limited training, staffing, and time), patient-level challenges (social needs and physical burden of COPD), and system-level challenges (lack of standardization, limited resources, and cost). Key facilitators included the presence of dedicated staff and the availability of pre-existing programs or infrastructure. The 3 most commonly chosen interventions for implementation were patient education (eg, inhaler education and COPD action plans), medication reconciliation, and post-discharge care (eg, post-discharge visits and pulmonary rehabilitation). This study demonstrates how the integration of implementation science and human-centered design approaches can yield valuable insights, beyond what either field could obtain separately, during the pre-implementation phase of COPD TOC program implementation development. Contextual assessments that capture diverse views are instrumental in designing feasible and relevant interventions. Future work will explore how pre-implementation insights relate to post-implementation outcomes across participating sites.

Chronic obstructive pulmonary disease (COPD) is a leading cause of mortality and morbidity among US adults, including recurrent emergency department (ED) visits and unplanned hospital admissions. Despite this, the transition of care (TOC) from the inpatient to outpatient setting remains under-studied. The objectives of the Reduce Respiratory Emergent Visits using Implementation Science Interventions Tailored to Setting (Reduce REVISITS) study are to conduct contextual assessments to inform implementation plans for COPD TOC interventions, conduct a cluster randomized trial evaluating implementation over 1 year of COPD TOC bundles, and monitor sustainment of implementation over a 2-year period across 20 sites. This pragmatic, multisite study uses a hybrid type II effectiveness-implementation design to evaluate clinical and implementation outcomes of COPD TOC programs across 20 sites. Sites are cluster-randomized to 1 of 4 intervention groups, varying by program delivery method (in-person vs virtual) and implementation strategy (mentored implementation with or without co-design). Sites select evidence-based interventions they wish to incorporate into their COPD TOC program and are randomized to in-person or virtual delivery. During the 1-year active implementation period of the study, assigned mentors will meet monthly with sites (for a total of 12 sessions) to enable on-the-ground troubleshooting of site-specific difficulties with TOC interventions. The primary effectiveness outcome for this study will be COPD-specific acute health care use, defined as a composite of all ED visits and hospitalizations within 30 days of index hospitalization for a COPD exacerbation. The primary implementation outcome will be reach, defined as the proportion of patients receiving their assigned TOC interventions (the whole bundle). As of August 2025, 21 sites completed the contextual assessments and developed site-specific implementation plans. Publication of the qualitative data from this pre-implementation phase is anticipated in December 2025. Site randomization is complete; sites randomized to co-design have completed 3 sessions. Baseline data collection on use is complete. Implementation-year data collection on use is nearly complete. Year 1 and 2 post-implementation-phase data collection on use is ongoing. Quantitative data analyses of the baseline and implementation-phase reports are nearly complete. Manuscript submission for the primary implementation-phase manuscript is anticipated for December 2025. Manuscript submission for the implementation-sustainment analyses are anticipated for September 2026. Qualitative data collection for year 1 of the post-implementation phase is complete, and analysis is under way. Qualitative data collection for year 2 began in August 2025. The Reduce REVISITS study will use novel integrated implementation science and human-centered design methodology to investigate bundles of effective COPD TOC interventions with the goal of reducing COPD hospital revisits. The study will evaluate evidence-based programs for effectiveness and implementation across a wide variety of health care sites to ultimately improve outcomes in this high-risk patient population. ClinicalTrials.gov NCT05568043; https://clinicaltrials.gov/study/NCT05568043. DERR1-10.2196/82043.