Chronic obstructive pulmonary disease (COPD) is a major cause of disability and mortality, affects more than 15 million individuals in the United States and is the fourth leading cause of death in the U.S. Because COPD is a progressive multifaceted illness, individuals require increasingly complex health care, are subjected to cycles of hospital admission, discharge, home care and unplanned hospital readmissions. The proposed quasi-experimental intervention study will examine the effectiveness of a program of transitional home health care directed and supervised by APNs for patients with COPD. The intervention group will receive home health care provided by APN supervised RNs and includes advanced assessment of physical, functional, psychological, coping, environmental and support systems. The control group will receive routine nursing home health care. Differences in patient functional status, pulmonary function, perceptions of health status and dyspnea tolerance, morbidity, anxiety, depression and patient satisfaction will be examined in the intervention and routine care groups. A sample size of 62 in each group is necessary for a statistical power of .80, using alpha one-tailed alpha of .05, moderate effect size .40 for statistical analysis with chi-square and t-test. The proposed study intends to provide data about patient outcomes and the effects of home health care services provided by APN supervised RNs compared to routine RN care. These data are important in developing interventions to improve home health care services and prospective ways to reduce rehospitalization for patients with COPD. Study data will also be important in documenting the scope of APN functions required by high risk patients such as those home health care patients with COPD. The design and method can be used to compare patient outcomes in other home health care patient groups. Moreover, the investigation of the effects of nursing care on patient outcomes will allow for examination of the most efficient interventions as well as provide data to develop more efficient interventions.
