Health coaching and chronic obstructive pulmonary disease rehospitalization: A randomized study

Roberto P Benzo, Kristin Vickers, Paul J. Novotny, Sharon Tucker, Johanna Hoult, Pamela Neuenfeldt, John Connett, Kate Lorig, Charlene McEvoy

Research output: Contribution to journalArticle

45 Citations (Scopus)

Abstract

Rationale: Hospital readmission for chronic obstructive pulmonary disease (COPD) has attracted attention owing to the burden to patients and the health care system. There is a knowledge gap on approaches to reducing COPD readmissions. Objectives: To determine the effect of comprehensive health coaching on the rate of COPD readmissions. Methods: A total of 215 patients hospitalized for a COPD exacerbation were randomized at hospital discharge to receive either (1) motivational interviewing-based health coaching plus a written action plan for exacerbations (the use of antibiotics and oral steroids) and brief exercise advice or (2) usual care. Measurements and Main Results: We evaluated the rate of COPD-related hospitalizations during 1 year of follow-up. The absolute risk reductions of COPD-related rehospitalization in the health coaching group were 7.5% (P = 0.01), 11.0% (P = 0.02), 11.6% (P = 0.03), 11.4% (P = 0.05), and 5.4% (P = 0.24) at 1, 3, 6, 9, and 12 months, respectively, compared with the control group. The odds ratios for COPD hospitalization in the intervention arm compared with the control arm were 0.09 (95% confidence interval [CI], 0.01-0.77) at 1 month postdischarge, 0.37 (95% CI, 0.15-0.91) at 3 months postdischarge, 0.43 (95% CI, 0.20-0.94) at 6 months postdischarge, and 0.60 (95% CI, 0.30-1.20) at 1 year postdischarge. The missing value rate for the primary outcome was 0.4% (one patient). Disease-specific quality of life improved significantly in the health coaching group compared with the control group at 6 and 12 months, based on the Chronic Respiratory Disease Questionnaire emotional score (emotion and mastery domains) and physical score (dyspnea and fatigue domains) (P<0.05). There were no differences between groups in measured physical activity at any time point. Conclusions: Health coaching may represent a feasible and possibly effective intervention designed to reduce COPD readmissions. Clinical trial registered with www.clinicaltrials.gov (NCT01058486).

Original languageEnglish (US)
Pages (from-to)672-680
Number of pages9
JournalAmerican Journal of Respiratory and Critical Care Medicine
Volume194
Issue number6
DOIs
StatePublished - Sep 15 2016

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Chronic Obstructive Pulmonary Disease
Health
Confidence Intervals
Hospitalization
Exercise
Motivational Interviewing
Patient Readmission
Numbers Needed To Treat
Control Groups
Mentoring
Dyspnea
Fatigue
Disease Progression
Patient Care
Emotions
Chronic Disease
Odds Ratio
Steroids
Quality of Life
Clinical Trials

Keywords

  • Chronic obstructive pulmonary disease
  • Communication skills
  • Health coaching
  • Hospitalizations
  • Quality of life

ASJC Scopus subject areas

  • Medicine(all)
  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

Cite this

Health coaching and chronic obstructive pulmonary disease rehospitalization : A randomized study. / Benzo, Roberto P; Vickers, Kristin; Novotny, Paul J.; Tucker, Sharon; Hoult, Johanna; Neuenfeldt, Pamela; Connett, John; Lorig, Kate; McEvoy, Charlene.

In: American Journal of Respiratory and Critical Care Medicine, Vol. 194, No. 6, 15.09.2016, p. 672-680.

Research output: Contribution to journalArticle

Benzo, RP, Vickers, K, Novotny, PJ, Tucker, S, Hoult, J, Neuenfeldt, P, Connett, J, Lorig, K & McEvoy, C 2016, 'Health coaching and chronic obstructive pulmonary disease rehospitalization: A randomized study', American Journal of Respiratory and Critical Care Medicine, vol. 194, no. 6, pp. 672-680. https://doi.org/10.1164/rccm.201512-2503OC
Benzo, Roberto P ; Vickers, Kristin ; Novotny, Paul J. ; Tucker, Sharon ; Hoult, Johanna ; Neuenfeldt, Pamela ; Connett, John ; Lorig, Kate ; McEvoy, Charlene. / Health coaching and chronic obstructive pulmonary disease rehospitalization : A randomized study. In: American Journal of Respiratory and Critical Care Medicine. 2016 ; Vol. 194, No. 6. pp. 672-680.
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abstract = "Rationale: Hospital readmission for chronic obstructive pulmonary disease (COPD) has attracted attention owing to the burden to patients and the health care system. There is a knowledge gap on approaches to reducing COPD readmissions. Objectives: To determine the effect of comprehensive health coaching on the rate of COPD readmissions. Methods: A total of 215 patients hospitalized for a COPD exacerbation were randomized at hospital discharge to receive either (1) motivational interviewing-based health coaching plus a written action plan for exacerbations (the use of antibiotics and oral steroids) and brief exercise advice or (2) usual care. Measurements and Main Results: We evaluated the rate of COPD-related hospitalizations during 1 year of follow-up. The absolute risk reductions of COPD-related rehospitalization in the health coaching group were 7.5{\%} (P = 0.01), 11.0{\%} (P = 0.02), 11.6{\%} (P = 0.03), 11.4{\%} (P = 0.05), and 5.4{\%} (P = 0.24) at 1, 3, 6, 9, and 12 months, respectively, compared with the control group. The odds ratios for COPD hospitalization in the intervention arm compared with the control arm were 0.09 (95{\%} confidence interval [CI], 0.01-0.77) at 1 month postdischarge, 0.37 (95{\%} CI, 0.15-0.91) at 3 months postdischarge, 0.43 (95{\%} CI, 0.20-0.94) at 6 months postdischarge, and 0.60 (95{\%} CI, 0.30-1.20) at 1 year postdischarge. The missing value rate for the primary outcome was 0.4{\%} (one patient). Disease-specific quality of life improved significantly in the health coaching group compared with the control group at 6 and 12 months, based on the Chronic Respiratory Disease Questionnaire emotional score (emotion and mastery domains) and physical score (dyspnea and fatigue domains) (P<0.05). There were no differences between groups in measured physical activity at any time point. Conclusions: Health coaching may represent a feasible and possibly effective intervention designed to reduce COPD readmissions. Clinical trial registered with www.clinicaltrials.gov (NCT01058486).",
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N2 - Rationale: Hospital readmission for chronic obstructive pulmonary disease (COPD) has attracted attention owing to the burden to patients and the health care system. There is a knowledge gap on approaches to reducing COPD readmissions. Objectives: To determine the effect of comprehensive health coaching on the rate of COPD readmissions. Methods: A total of 215 patients hospitalized for a COPD exacerbation were randomized at hospital discharge to receive either (1) motivational interviewing-based health coaching plus a written action plan for exacerbations (the use of antibiotics and oral steroids) and brief exercise advice or (2) usual care. Measurements and Main Results: We evaluated the rate of COPD-related hospitalizations during 1 year of follow-up. The absolute risk reductions of COPD-related rehospitalization in the health coaching group were 7.5% (P = 0.01), 11.0% (P = 0.02), 11.6% (P = 0.03), 11.4% (P = 0.05), and 5.4% (P = 0.24) at 1, 3, 6, 9, and 12 months, respectively, compared with the control group. The odds ratios for COPD hospitalization in the intervention arm compared with the control arm were 0.09 (95% confidence interval [CI], 0.01-0.77) at 1 month postdischarge, 0.37 (95% CI, 0.15-0.91) at 3 months postdischarge, 0.43 (95% CI, 0.20-0.94) at 6 months postdischarge, and 0.60 (95% CI, 0.30-1.20) at 1 year postdischarge. The missing value rate for the primary outcome was 0.4% (one patient). Disease-specific quality of life improved significantly in the health coaching group compared with the control group at 6 and 12 months, based on the Chronic Respiratory Disease Questionnaire emotional score (emotion and mastery domains) and physical score (dyspnea and fatigue domains) (P<0.05). There were no differences between groups in measured physical activity at any time point. Conclusions: Health coaching may represent a feasible and possibly effective intervention designed to reduce COPD readmissions. Clinical trial registered with www.clinicaltrials.gov (NCT01058486).

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