Helping Patients with COPD Transition from Hospital to Home -- The BREATHE Study

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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.

Objective

To compare a hospital-to-home transition program with usual posthospital care for patients with chronic obstructive pulmonary disease (COPD)

Study Design

This randomized controlled trial compared the effectiveness of the Better Respiratory Education and Treatment Help Empower (BREATHE) program versus usual care on improving patients’ quality of life and COPD-related hospitalizations and emergency department (ED) visits at one urban academic medical center serving patients with low incomes.

The research team randomly assigned patients with COPD to receive either the BREATHE program or usual care. In the BREATHE program, a COPD nurse reviewed a postdischarge care plan with patients while they were in the hospital. Then, while at the hospital and for up to three months after discharge, the nurse provided individualized education focused on COPD self-management, social support, and connections to community resources. Nurses received training for this role.

In the usual care group, a hospital physician or nurse provided education to patients while they were in the hospital. Usual care services focused on facilitating transition to home rather than on long-term COPD self-management. The hospital assigned general transition guides to provide these services to each patient for the first month after discharge. The transition guides were nurses trained in care coordination and coaching to encourage adherence to the discharge plan and follow-up with outpatient providers.

The study included 240 patients with COPD in Baltimore, Maryland. Of these, 83% were white, 16% were black, and 1% were other races. The average age was 65, and 62% were female.

To assess health-related quality of life, patients completed surveys via interview during their hospital stays and via telephone one week, one month, three months, and six months postdischarge. To assess hospital and ED visits (all-cause and due to COPD), the research team reviewed patients’ medical records at one, three, and six months.

Patients, family members, doctors, nurses, and COPD advocacy groups worked with the research team to develop the BREATHE program. A group of patients with COPD and caregivers worked with the team throughout the study to monitor study conduct.

Results

At six months, quality of life did not differ between patients in the BREATHE program and those who received usual care.

Compared with patients who received usual care, patients in the BREATHE program had more combined COPD-related hospitalizations and ED visits at six months (BREATHE program mean=1.4 visits, usual care mean=0.72 visits, p=0.004).

Limitations

The study took place in a single academic medical center, and most patients were white. Results may be different in other locations or for people from other backgrounds.

Conclusions and Relevance

In this study, an individualized, three-month program for patients with COPD did not improve posthospital quality of life or reduce COPD-related hospitalizations and ED visits compared with usual care.

Future Research Needs

Future research could continue to explore ways to improve quality of life after hospitalization for COPD.