Results Summary

What was the research about?

Chronic obstructive pulmonary disease, or COPD, is a lung disease that makes it hard to breathe. When patients with COPD leave the hospital, they risk having more breathing problems that can bring them back to the hospital. Helping patients learn how to manage COPD at home may reduce this risk.

In this study, the research team wanted to learn if a program called BREATHE helped patients with COPD go from the hospital to home. In this program, a nurse taught patients in the hospital how to manage COPD and helped them get ready to go home. Then, for up to three months, the nurse visited patients at home to talk about ways they could manage COPD. The nurse also asked what help patients needed and told them about community resources to help meet these needs.

The research team compared patients in the BREATHE program with patients who received usual care. Patients who received usual care learned about COPD from a hospital doctor or nurse. After leaving the hospital, these patients could talk with a nurse assigned to them by the hospital for a month about how to follow their discharge plans and get access to healthcare services.

What were the results?

After six months, patients in the BREATHE program and patients who received usual care didn’t differ in quality of life. Compared with patients who received usual care, patients in the BREATHE program had more return visits to the hospital or emergency room for COPD.

Who was in the study?

The study included 240 patients with COPD admitted to a hospital in Baltimore, Maryland. Of these, 83 percent were white, 16 percent were black, and 1 percent were other races. The average age was 65, and 62 percent were women.

What did the research team do?

The research team assigned patients by chance to receive either the BREATHE program or usual care. The team trained nurses to work with patients in the BREATHE program.

Patients took surveys in the hospital and again one week, three months, and six months after going home. The research team also looked at patients’ health records to see if they returned to the hospital or emergency room.

To create the BREATHE program, the research team worked with patients with COPD, caregivers, doctors, and nurses. A group of patients and family members gave feedback to the team throughout the study.

What were the limits of the study?

The study took place at one hospital, and most patients in the study were white. Results may differ in other hospitals and with other patients.

Future research could look for other ways to improve quality of life after a hospital stay for patients with COPD.

How can people use the results?

Hospitals can use the results when considering ways to help patients with COPD as they go from the hospital to home.

Note: Lead investigator Hanan Aboumatar, MD, MPH, identified an error in the original analysis for this study. On October 8, 2019, JAMA published a corrected version of the paper along with an Editorial, Editor's Note, and a Notice of Retraction from Dr. Aboumatar. JAMA has made the full text of all four articles available free of charge. The abstracts posted here present the study’s corrected findings.

Final Research Report

View this project's final research report.

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 reviewers commented, and the researchers made changes or provided responses. The comments and responses included the following:

  • Reviewers asked for greater clarity on eligibility criteria for the study, especially related to what researchers had included in their definition of chronic obstructive pulmonary disease -related conditions. Reviewers also asked why researchers did not measure airflow obstruction when establishing a diagnosis of chronic obstructive pulmonary disease. The researchers responded that in order to make the study more feasible, they based participant inclusion on medical records, automated reporting, and physician confirmation, rather than direct diagnosis of chronic obstructive pulmonary disease. The researchers included participants who either had been diagnosed with acute chronic obstructive pulmonary disease when hospitalized or had their chronic obstructive pulmonary disease contribute to their hospitalization. In addition, many hospitalized patients do not have their airflow obstruction measured to establish a diagnosis.
  • Reviewers asked for more discussion about the lack of significant effect on many secondary outcomes. The researchers responded that the study was not well powered to detect differences in secondary measures and added detail to their discussion about these results.
  • Reviewers asked why approximately 35 percent of eligible participants declined to participate and whether there was additional information about those who declined. The researchers said reasons included lack of time and interest, and involvement in other studies. However, they said the demographic characteristics of the group that participated were comparable to those of all the eligible patients. The researchers added details about these groups to the report.
  • Reviewers suggested that a longer follow-up, beyond three months and six months, might have been helpful. The researchers agreed and said they would like to conduct longer follow-up on the study participants, noting that the benefits of some intervention strategies take additional time to emerge.

Conflict of Interest Disclosures

Project Information

Hanan J. Aboumatar, MD, MPH
Johns Hopkins University
An Integrative Multilevel Study for Improving Patient-Centered Care Delivery among Patients with Chronic Obstructive Pulmonary Disease

Key Dates

September 2013
October 2018

Study Registration Information


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Last updated: April 18, 2024