In patients hospitalized for chronic obstructive pulmonary disease (COPD) exacerbation, multidisciplinary monitoring and follow up interventions during the 6 months following hospital discharge improved quality of life but did not reduce readmission or death rates, according to study results published in the American Journal of Respiratory and Critical Care Medicine.
Although research indicates that up to half of patients hospitalized for a COPD exacerbation may be readmitted within 6 months, such patients typically receive no follow up health interventions post hospital discharge. Studies examining how to reduce hospital readmission for these patients have yielded contradictory outcomes as to the value of follow up and the best way to prevent readmissions. In the current study, researchers sought to discover whether monitoring and interventions for these patients based on a virtual review by multidisciplinary health care providers could improve these patients’ quality of life and reduce all-cause 180-day readmission/mortality. Quality of life was measured via the Clinical COPD Questionnaire (CCQ).
Study researchers conducted a stepped-wedge multi-center clinical trial (ClinicalTrials.gov Identifier: NCT02021955) from May 2015 through November 2017. The trial included 365 primary care providers (PCPs) caring for 352 patients discharged following COPD exacerbation from the VA Puget Sound Health Care System and the Boise VA Medical Center and 10 outpatient clinics. PCPs were randomized into 30 clusters; 191 eligible patients were assigned to the control cohort, and 161 patients to an intervention cohort.
For the intervention cohort, a multidisciplinary intervention team (made up of pulmonary, primary care, and pharmacy providers) reviewed patient health information and made recommendations as “an unsolicited E-consult” delivered virtually to primary care providers. Initial recommendations were made within 7±4.3 days of patient discharge. In general, recommendations involved diagnostic, pharmacologic, and nonpharmacologic care, including behavioral health. The most common recommendations were pulmonary rehabilitation, modifications made to patients’ inhaled therapies, and additional diagnostic imaging. Overall, 77.3% of recommendations made by the interdisciplinary team were endorsed by patients’ PCPs.
In evaluating the effect of intervention on quality of life, the study investigators found that CCQ scores 6 weeks after discharge were better for the intervention cohort (-0.47; 95% CI, – 0.85 to -0.09). However, the study authors also noted that 52.6% of CCQ test scores were missing (ie, not completed). In evaluating the other outcomes, researchers found that 180-day mortality or readmission rates were 37.9% in the intervention cohort vs 44.0 % in the control cohort, a difference that researchers found was not significant (aOR 0.83; 95% CI, 0.49-1.38).
The researchers concluded that their study “demonstrated that a proactive, virtual intervention improved the quality of life of patients after discharge for COPD exacerbation. The intervention realigned specialty care services to work in an interdisciplinary fashion with primary care providers using population management tools and addressing common geospatial and temporal barriers.”
Study limitations included sample size, design constraints, and lack of uniformity in PCP services.
Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Au DH, Collins MP, Berger DB, et al. Health system approach to improve COPD care after hospital discharge: Stepped wedge clinical trial. Am J Respir Crit Care Med. Published online March 25, 2022. doi:10.1164/rccm.202107-1707OC