Results Summary
What was the research about?
People with chronic obstructive pulmonary disease, or COPD, have a hard time breathing and cough often. Although there is no cure for COPD, treatments can help patients’ symptoms. But managing care for COPD can be complex. Patients need frequent doctor visits and often take more than one medicine. Patients with low incomes may have fewer resources to help them manage their care.
In this study, the research team wanted to know whether support from a health coach would help patients with COPD who have low incomes improve their quality of life, breathe easier, and improve their ability to manage their own care compared with people who didn’t work with a health coach. Health coaches support people in making everyday decisions about their health, like taking medicines, exercising, or quitting smoking.
What were the results?
When comparing patients who worked with a health coach with those who didn’t, the study found no difference in
- Quality of life
- Ease of breathing
- Ability to manage COPD
- Ability to exercise
- Number of COPD emergencies
Who was in the study?
The study included 192 patients with COPD living in San Francisco, California. Of these patients, 57 percent were African American, 21 percent were white, and 22 percent were other races. In addition, 10 percent spoke Spanish, 44 percent made less than $10,000 a year, and 13 percent were homeless. The average age was 62, and 66 percent of patients were male.
What did the research team do?
The research team recruited patients from seven health clinics. These clinics serve patients who have low incomes and who have public insurance. The team assigned patients by chance to receive either their usual care plus a health coach for nine months, or to receive usual care only.
For this study, the research team trained two health coaches to actively listen to patients and to help them set goals for managing their COPD. Coaches received 100 hours of training over three months and spoke English and Spanish. Patients in the health-coaching group met with their coach in person at least three times. They also talked with their coach at least once every three weeks on the phone. A coach went with each patient to at least one doctor’s visit. A nurse practitioner with experience caring for patients with COPD met with the coaches to review each patient’s information and share medical advice with the coach. The nurse practitioner also entered the advice into the patient’s electronic health record, so their doctor could see it.
Patients in both groups continued with their regular doctor visits during the nine-month study.
During the study, the research team worked with patients with COPD, clinic staff, public health officials, and experts in COPD. These people helped the team design the study, recruit and keep patients, and review findings.
What were the limits of the study?
The study took place in one city. Results might be different for people living in other areas.
Future research could look at other ways to improve quality of life for patients with COPD who have low incomes and live in urban areas.
How can people use the results?
Clinics may use these results when working to support patients with low incomes who have COPD.
Professional Abstract
Objective
To examine the effectiveness of health coaching plus usual care for improving quality of life, dyspnea, and self-management outcomes in patients with chronic obstructive pulmonary disease (COPD) compared with usual care alone
Study Design
Design Elements | Description |
---|---|
Design | Randomized controlled trial |
Population | 192 patients with moderate to severe COPD and low incomes |
Interventions/ Comparators |
|
Outcomes |
Primary: COPD-related quality of life, dyspnea Secondary: self-efficacy for COPD self-management, exercise capacity, number of COPD exacerbations |
Timeframe | 9-month follow-up for primary outcomes |
This randomized controlled trial compared health coaching plus usual care with usual care alone for patients with moderate to severe COPD. The research team recruited 192 patients from seven federally qualified health centers in San Francisco, California. Of these patients, 57% were African American, 21% were white, and 22% were other races. The average patient age was 62, 10% were Spanish speakers, and 66% were male. In addition, 44% of patients reported earning less than $10,000 per year, and 13% were homeless or marginally housed.
The research team randomized patients to either the intervention or usual care group. For the intervention, the team trained two health coaches in skills such as active listening, goal setting, and managing COPD. The coaches received 100 hours of training over three months. Both coaches were bilingual in Spanish and English. Patients in the intervention group met with their coach by phone every three weeks and in person at least three times during the nine-month study. Coaches also attended at least one appointment with each patient and their primary care provider. In addition, a pulmonary nurse practitioner specialist provided the health coaches with one in-depth consultation. The nurse practitioner made patient-specific recommendations for managing COPD and entered that advice into each patient’s electronic health record for their primary care provider to see.
During the study, patients in both groups continued their regular visits with their primary care providers. Usual care included standard COPD care, such as COPD education, respiratory therapy, smoking cessation classes, and rehabilitation.
The research team collected data from the patients before randomization and again three, six, and nine months later.
The research team worked with patients with COPD, health clinic administrators and staff, clinicians, pulmonary specialists, experts in patient education, and San Francisco Department of Public Health system leadership. These advisors helped to design the study, recruit and retain participants, and review findings.
Results
The study found no significant differences between the two groups in COPD-related quality of life, dyspnea, self-efficacy for COPD self-management, exercise capacity, or number of COPD exacerbations.
Limitations
Randomization took place at the patient level rather than the clinic level. Because the coaches were working in all clinics, they may have influenced provider behavior overall, affecting both the health-coaching group and the usual-care group.
The research team recruited patients with low incomes from health clinics in one urban area; results may be different for patients with higher incomes or patients in other locations.
Conclusions and Relevance
This study found no difference in COPD-related quality of life or dyspnea between the health-coaching and usual-care groups.
Future Research Needs
Future research could explore other means to improve COPD-related quality of life and dyspnea for patients with low incomes in urban areas.
Final Research Report
View this project's final research report.
Journal Citations
Results of This Project
Related Journal Citations
Peer-Review Summary
Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.
The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments.
Peer review identified the following strengths and limitations in the report:
- The reviewers acknowledged the importance of this research for advancing care for people with chronic obstructive pulmonary disease (COPD). They felt that the patient and stakeholder engagement section of the report in particular provided an excellent model for how to conduct engagement in similar research.
- The reviewers requested more details on the usual care arm of the study, noting that it would help clinicians and administrators compare their own clinic procedures to those in the clinics in the study. The researchers provided additional information, noting also that the comparator clinics did not provide care management services for patients on controller medications.
- Based on reviewers’ comments, the researchers added to their study limitations section by acknowledging that because providers treated patients in the health coaching arm as well as the usual care arm, there may have been a halo effect, whereby providers used some of the information they learned from the intervention in treating control group patients. This could reduce the differences between study groups.