Chronic Obstructive Pulmonary Disease (COPD) affects 16 million US adults, many of whom experience high rates of emergency department and hospital COPD revisits after initial hospitalizations due to care transition failures. These frequent COPD exacerbations lead to more rapid lung function decline and earlier mortality. Further, hospitalizations for exacerbations highly contribute to the ~$50 billion spent annually for COPD care in the US. Therefore, COPD revisits are now a public health crisis. It is feasible to improve COPD care and decrease acute care revisits, as shown by published evidence of successful care transition interventions. Our team has led efforts to identify effective care transition interventions and has successfully piloted a multi-level COPD care transition program. Effective care transition interventions include medication reconciliation, self- management education, and post-discharge communication. However, for wide-spread adoption to occur, we must identify optimal intervention delivery methods based on hospitals' resources and patient care needs. For instance, virtually-supported interventions are often more resource-friendly, and while effectiveness data on individual virtual interventions exists, multi-level virtual programs have not yet been studied compared to in- person programs. In addition, feasible implementation approaches to support the delivery of evidence-based care transition programs are needed for wide-scaled dissemination and sustainability. Our team has found that a mentored implementation model is effective for implementing multi-level, hospital-based programs across US health systems. This approach traditionally relies on in-person site visits. The use of virtual site visits could dramatically increase this model's reach, but has not yet been studied. In summary, for successful, wide-scale adoption, diverse US hospitals need to have access to feasible, multi-level care transition programs and effective implementation approaches that are aligned with site-specific care needs and resources, but currently the optimal approach is unknown. Thus, in this proposal, we will compare the effectiveness of virtual vs. in- person multi-level COPD care transition programs in real-world settings by concurrently studying whether virtual or in-person mentored implementation increases programs' reach. We will collaborate with the Hospital Medicine Reengineering Network convened for rapid discovery and dissemination to identify and enroll sites. After conducting pre-implementation contextual assessments at all sites using the Consolidated Framework for Implementation Research, we will conduct a Hybrid Type II Effectiveness-Implementation study to determine effectiveness of the programs to reduce 30-day COPD revisits and of the mentored implementation to increase program penetration. Finally, we will study programs' sustained outcomes for two years post-implementation. Data from this study will inform the optimal implementation of COPD care transition programs at scale. Further, lessons gleaned from this study can inform implementation approaches for other hospital-based programs.
Chronic Obstructive Pulmonary Disease (COPD) burdens over 16 million US adults and frequently results in recurrent emergency department visits and hospitalizations due to poor care transition support after initial COPD exacerbations. Our study will use innovative and rigorous implementation science methods to identify real-world solutions to decreasing COPD acute care revisits by concurrently studying care transition program intervention delivery methods (virtual versus in-person) and mentored implementation approaches (virtual or in-person). Lessons learned from this study could transform the way in which care is delivered to millions of COPD patients across the US and could even be applied widely to improve the effectiveness and sustainability of other multi-level, hospital-based programs.
