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Randomized Controlled Trial
. 2018 Apr 24:13:1325-1332.
doi: 10.2147/COPD.S154414. eCollection 2018.

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

Ashley W Collinsworth  1   2 , Rachel M Brown  1 , Cameron S James  3 , Richard H Stanford  3 , Daniel Alemayehu  1 , Elisa L Priest  1
Affiliations
Randomized Controlled Trial

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

Ashley W Collinsworth et al. Int J Chron Obstruct Pulmon Dis. .

Abstract

Purpose: 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.

Patients and methods: 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).

Results: 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 (P=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 P=0.231). Patients experienced significant improvement from baseline in mean PAM (both groups) and CAT (CCC group) scores.

Conclusion: 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.

Keywords: COPD; chronic disease management; hospital readmission; patient education; shared decision making.

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Conflict of interest statement

Disclosure RHS is an employee of GSK and holds stocks/shares in GSK. CSJ is a current employee of Sanofi and was an employee of GSK during the study and still holds stocks/shares in GSK. AWC, RMB, DA, and ELP have received research funding from GSK. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Patient disposition.
Figure 2
Figure 2
Time to all-cause readmission (inpatient, ED, or outpatient). Notes: Outpatients: classified as patients with short stay or 24-hour observation and not admitted as inpatients. Cross mark indicates patient death. Abbreviations: CCC, COPD Chronic Care; ED, emergency department.
Figure 3
Figure 3
Time to first COPD-related readmission (inpatient, ED, or outpatient). Notes: Outpatients: classified as patients with short stay or 24-hour observation and not admitted as inpatients. Cross mark indicates patient death. Abbreviations: CCC, COPD Chronic Care; ED, emergency department.
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