Chronic obstructive pulmonary disease (COPD) is one of the most common chronic diseases worldwide and is a frequent cause of hospital admissions and readmissions. Hospitalization for a COPD exacerbation is an important event for patients because it may signal the beginning of the terminal phase of illness and is associated with a significant decline in the quality of life and chances of survival. It is an important event for the healthcare system because hospitalization accounts for 70% of COPD-related costs in the United States. Based on a validated theoretical framework, previous literature and on our preliminary data we designed a multi-component intervention for COPD which will be initiated at hospital discharge aimed to decrease re- hospitalization. The intervention will include permanent access to a nurse that will integrate pulmonary rehabilitation, will promote self-management by increasing self efficacy using motivational interviewing and will increase communication between the patient/family continuum and the primary care team. This study plan to test the following hypotheses using a randomized control trial (RCT)design: (1) The rate and number of hospitalizations will be at least 20% lower in the intervention group than in the control group (2) At 6-month and 12-month follow-ups, the physical activity level measured in terms of the average number of steps , minutes spent in physical activities of moderate intensity (METS>2.5) per day and active energy expenditure will be higher in the intervention group than in the control group.
Aim 1 : To determine the impact of the intervention initiated at the time of hospital discharge from a COPD exacerbation on the rate and number of hospitalizations after 12 months of follow-up.
Aim 2 : To determine the impact of the intervention on increasing and maintaining physical activity after a hospitalization for a COPD exacerbation assessed by an activity monitor at 3, 6 and 12 months.
Aim 3 : To determine the impact of the intervention on self efficacy for physical activity and disease management at 3, 6 and 12 months.
Aim 4 : To determine the impact of the intervention on health status at 3, 6 and 12 months.
Aim 5 (exploratory): To determine predictors of hospitalization, low physical activity and predictors of the change in physical activity, self efficacy and health status. Identifying predictors will allow stronger interventions and attention to those patients with higher risk for inactivity or re-hospitalizations. Predictors of change will identify patients with higher chance to respond to similar interventions (higher change over time in study outcomes).
This is an intervention aiming to decrease hospitalization and to increase and maintain physical activity by consistent patient motivation. We anticipate that the effect of this intervention if successful will be not only important to patients (clinically meaningful) but also extremely cost effective as 70% of the cost of the COPD in the US comes from hospitalizations alone. This intervention calls for a structural change in the way people with COPD are cared for, and the participation of nurses, and patients themselves. Positive results from this trial may change the standard of care for patients with severe COPD and modify practices that have been entrenched for many years. The trajectory analysis of the different perceptions of health status coming directly from patients (patient reported outcomes) will be of critical importance to design future COPD interventions.
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