A 3-month program of combined transition and long-term self-management support was associated with increased disease-related hospitalizations and emergency department visits in a small study of patients who were hospitalized because of chronic obstructive pulmonary disease (COPD), according to study findings published in the Journal of the American Medical Association.1
Investigators conducted the study at a single site in Baltimore, Maryland, enrolling a total of 240 participants who were hospitalized because of COPD (mean age, 64.9±9.8 years). They randomly assigned patients to usual care (n=120) or to an intervention group (n=120). The intervention group consisted of nurse-delivered education to help in the transition of patients to discharge, individualized COPD self-management support, and facilitated access to treatment services and community programs.
Participants and their caregivers received the intervention over a 3-month period, and the researchers followed patients for 6 months after discharge. The 6-month primary end point was the number of COPD-related acute care events, including hospitalizations and emergency department visits. Investigators also examined changes in health-related quality of life at 6 months, as assessed by the St George’s Respiratory Questionnaire (SGRQ).
At baseline, the mean SGRQ score was 62.3±18.8 in patients randomly assigned to intervention vs 63.6±17.4 in patients randomly assigned to usual care. A greater mean number of COPD-related acute care events at 6 months was observed in the intervention (1.4; 95% CI, 1.01-1.79) vs the usual care (0.72; 95% CI, 0.45-0.97) groups (difference, 0.68; 95% CI, 0.22-1.15; P =.004). There was no difference between intervention and usual care in terms of the mean change in SGRQ total score at 6 months (2.81 vs -2.69, respectively; adjusted difference, 5.18; 95% CI, -2.15 to 12.51; P =.11). During the study period, there were 202 hospitalizations in the intervention group vs 137 hospitalizations in the usual care group.
Limitations of the study included the recruitment of patients from a single site and the inclusion of mostly low-income and less-educated patients.
Previous to publishing these findings, the current authors published findings of a study showing a benefit of the intervention in this population. After publication, the authors found a coding error that actually reversed the findings. In effect, the transition and supportive care program was found to be associated with an increased risk for hospitalization, and the publication was retracted and subsequently republished.
According to an accompanying editorial by Seppo T. Rinne, MD, PhD, and coauthors, inherent characteristics of the 3-month intervention may have contributed to a clinical deterioration in patients with COPD.2
“Self-management programs could cause these patients to become overconfident in their abilities and delay seeking care at times that may have mitigated adverse events,” the authors wrote.
They also suggested that the intervention may have resulted in patients becoming more aware of respiratory symptoms, leading them to “seek higher levels of care that, in turn, contributed to significantly increased acute care events.”
Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.
1. Aboumatar H, Naqibuddin M, Chung S, et al. Effect of a hospital-initiated program combining transitional care and long-term self-management support on outcomes of patients hospitalized with chronic obstructive pulmonary disease: a randomized clinical trial. JAMA. 2019;322(14):1371-1380.
2. Rinne ST, Lindenauer PK, Au DH. Unexpected harm from an intensive COPD intervention. JAMA. 2019;322(14):1357-1359.