A comprehensive 3-month program combining transition and long-term self-management support for patients with chronic obstructive pulmonary disease (COPD) and their caregivers led to significantly fewer COPD-related hospitalizations and emergency department (ED) visits and greater quality of life compared with a standard of care program, according to a study published in the Journal of American Medical Association.
In this study, the researchers randomly assigned 240 participants with COPD, as part of a single-site, controlled trial, to receive either a comprehensive 3-month program to help patients and their caregivers self-manage COPD long-term (n=120), or the usual standard of care (n=120). The usual standard of care was described as transition support for 30 days post-discharge with oversight over discharge plan adherence and connection to outpatient care. Data collection occurred during telephone calls with patients post-discharge at 1 week and 1, 3, and 6 months.
Primary outcomes were defined as the number of COPD-related acute care events (hospitalizations and ED visits) per participant 6 months post-discharge. A coprimary outcome was defined as the change in participants’ health-related quality of life, which was measured by the St George’s Respiratory Questionnaire (SGRQ) score 6 months post-discharge. Secondary outcomes were the 6-month mortality rate and time to death or first COPD-related hospitalization or ED visit.
A total of 203 participants (85%) completed the study. In the intervention group, the mean (standard deviation) baseline SGRQ score was 63.1 (19.9), compared with 62.6 (19.3) in the usual care group. At 6 months, the difference in the mean number of COPD-related acute care events per participant between the intervention group and usual care group was significant at 0.68 (95% CI, 0.22-1.15; P =.004). In addition, the mean number of COPD-related acute care events per participant was 0.72 (95% CI, 0.45-0.97) in the intervention group and 1.40 (95% CI, 1.01-1.79) in the usual care group. At 6 months, the mean change in participants’ SGRQ total score was significant at −1.53 in the intervention group and +5.44 in the usual care group (adjusted difference, −6.69; 95% CI, −12.97 to −0.40; P =.04).
The researchers noted several limitations to the study, one of which was the lack of generalizability because of the results were derived from a single site. Another important limitation mentioned was that, because spirometry evidence of airflow obstruction was not required for enrollment, some of the study participants may have had a false diagnosis of COPD. Given these limitations, the authors concluded that additional research is needed in other settings to corroborate their findings.
Disclosures: Investigators report multiple associations with the pharmaceutical industry. Please see the original reference for a full list of disclosures.
Aboumatar H, Naqibuddin M, Chung S, et al. Effect of a program combining transitional care and long-term self-management support on outcomes of hospitalized patients with chronic obstructive pulmonary disease: a randomized clinical trial [published online November 12, 2018]. JAMA. doi:10.1001/jama.2018.17933