Chronic obstructive pulmonary disease (COPD) is the third leading cause of 30-day hospital readmissions in the US. Improving the quality of care for hospitalized patients with COPD has recently become a national priority through the Centers for Medicare and Medicaid Services' Hospital Readmissions Reduction Program. There is extensive evidence to support the efficacy of inhaled medications to control and reduce symptoms of COPD and to improve patient outcomes. However, the real-world effectiveness of these medications is often limited due both to poor inhaler technique and insufficient medication adherence. Most interventions focus on medication reconciliation, treatment optimization, and inhaler technique education during hospitalization. However, after discharge home, patients quickly lose inhaler technique skills, have difficulty adhering to complex regimens, and lack physiologic feedback tools. Interventions to reinforce these skills and support improved adherence are needed to reduce the risk of deleterious outcomes. Through our novel, at-home ?BREATHES? (Bringing Respiratory Education for improved Adherence and Technique Home through E- interventions for Self-management) Program, patients can receive this needed on-going self-management support. The ?BREATHES? Program includes interventions to reinforce inhaler skills through virtual Teach-To- Goal (V-TTG) training session(s) and to improve medication adherence through physiologic feedback obtained using a handheld device to obtain at-home spirometry. The V-TTG intervention uses novel adaptive learning features that allow learners to participate in tailored educational sessions. My studies to date demonstrate participants' reported willingness to use V-TTG at-home for post-discharge booster education, and show that V-TTG is non-inferior to in-person TTG in significantly reducing inhaler misuse among inpatients. However, whether participants will adhere to the at-home V-TTG session, if repeating the V-TTG session at home will maintain self-management skills over the longer term, and how direct physiologic monitoring impacts medication adherence, is not yet known. Our novel idea is to pair V-TTG with at-home measurements of spirometry so as to combine self-testing of lung function and medication adherence support. These data are needed prior to conducting larger-scale R01 randomized studies of the BREATHES hospital ?to-home transition program for optimal COPD treatment. My central hypothesis is that COPD patients who complete the at-home BREATHES Program will retain increased medication knowledge, skill, and adherence that otherwise decays substantially by 30 days post-discharge. I will test this hypothesis through a quasi- experimental interventional study to evaluate the feasibility, adherence, and effectiveness of the at-home V- TTG session to provide inhaler skill training (Aim 1) and the use of the handheld SpiroPD device for lung function monitoring and medication adherence support (Aim 2).
The ?Bringing Respiratory Education for improved Adherence and Technique Home through E-interventions for Self-management (BREATHES) Program? is a novel, comprehensive approach for providing high-risk, recently hospitalized COPD patients with much needed self-management support in their homes. This proposal will test the use of innovative approaches to self-directed self-management skill training and patient-obtained physiologic feedback through handheld spirometry for medication adherence support. The data from this proposal will be critical for the development of future R01 studies that assess the impact of this novel hospital- to-home self-management program on clinical and public health outcomes.
