Journal Article

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

James, Cameron S, Brown, Rachel M, Priest, Elisa, Stanford, Richard H, Collinsworth, Ashley W, Alemayehu, Daniel

2018

Overview

Education 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. This 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). Overall, 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 ( =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 =0.231). Patients experienced significant improvement from baseline in mean PAM (both groups) and CAT (CCC group) scores. Utilizing 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.

• Publisher: Dove Medical Press Limited,Dove Medical Press Ltd,Dove Medical Press
• Subject: Aged / Aged, 80 and over / Attitude of Health Personnel / Body mass index / Chronic diseases / Chronic obstructive lung disease / chronic obstructive pulmonary disease / Clinical Decision-Making / Clinical outcomes / Codes / Comorbidity / Decision Making / Demographics / Disease management / Education / Feasibility Studies / Female / Health care access / Health education / Health Knowledge, Attitudes, Practice / Health Status / Hospital admission and discharge / Hospital patients / hospital readmission / Hospitals / Hospitals, Community / Humans / Length of stay / Male / Middle Aged / Original Research / Patient admissions / Patient Care Team / Patient compliance / Patient education / Patient Education as Topic / Patient Participation / Patient Readmission / Pilot Projects / Program Evaluation / Prospective Studies / Pulmonary Disease, Chronic Obstructive - diagnosis / Pulmonary Disease, Chronic Obstructive - physiopathology / Pulmonary Disease, Chronic Obstructive - psychology / Pulmonary Disease, Chronic Obstructive - therapy / Quality of life / Review boards / Self Care - methods / shared decision making / Texas / Time Factors / Tuberculosis