Self-Care COPD Program Lowered Hospital Readmissions

Hanan Aboumatar, MD, MPH

A new study demonstrates that clinical care centered on long-term self-management of chronic obstructive pulmonary disease (COPD) could significantly reduce the number of hospital readmissions and increase patient quality of life.

In collaboration with COPD patients and their caregivers, investigators developed and the study at Johns Hopkins Bayview Medical Center. The three-month BREATHE program combined transition support and chronic disease self-management, with the aim of improving quality of life and acute care reduction.

COPD encompasses a group of conditions, including emphysema and chronic bronchitis that causes irreversible lung damage. More than 1 of every 10 seniors have COPD, and 1 of 5 people admitted into the hospital with a COPD exacerbation are re-hospitalized within a month.

Lead author Hanan Aboumatar, MD, MPH, associate professor of medicine at the Johns Hopkins University School of Medicine, noted that people with COPD have to maintain a meticulous juggling act: learning about the various medications they must take, how to use multiple inhalers, maintaining the ability to do the activities they enjoy, and recognizing flare-ups early before they get serious enough to warrant a hospital admission.

“All of this requires a fair bit of learning about COPD, and is daily work for the patient and their caregivers,” Aboumatar said. “Unfortunately, patients often report not receiving sufficient information about COPD and how to manage it. Many don’t know how to use their inhalers or how to get portable oxygen devices so they can still leave their home.”

Between March 2015 and May 2016, 240 patients were randomized to receive usual care or intervention care. Usual care patients were assigned a general transition coach who supported the patient for 30 days after discharge providing guidance with a discharge plan and outpatient services. For intervention care, nurses, with specialized training in supporting COPD patients, met with patients during their hospital stay and for 3 months after discharge.

Hospitalizations, emergency department visits, and the St. George’s Respiratory Questionnaire (SGRQ) quality of life score were monitored for 6 months (0 being the best, 100 the worst) after initial hospitalization. For the 203 patients who completed the study, the number of COPD-related acute events was 0.72 for the intervention group (95% CI: 0.45 - 0.97) and 1.40 in the usual care group (95% CI: 1.01 - 1.79).

The SGRQ score for the intervention group decreased by only 1.53 points; however, the score for the usual care group showed a notable rise, at 5.44 points.

Aboumatar said the COPD patients and caregivers that partnered with their research team to develop the BREATHE program had unique perspectives, sharing important information about their needs and what areas healthcare providers needed to focus on.

“We are planning to repeat this study in a wider variety of hospitals, including ones in rural settings and those serving patients who have more access to resources,” she added

The study, “Effect of a Program Combining Transitional Care and Long-term Self-management Support on Outcomes of Hospitalized Patients with COPD," was published online in JAMA.