Background: Chronic obstructive pulmonary disease (COPD) is the third leading cause of death in the United States. The personal, social, and economic costs of the disease are tremendous, mostly from hospitalizations for flare-ups. Despite optimal medical therapy, many patients living with COPD still experience breathlessness and respond over time by withdrawing from their usual physical activity. However, research shows that patients who are physically inactive are more likely to have frequent hospitalizations and are at increased risk of dying. We also know that exercise training as part of pulmonary rehabilitation improves the outcomes of greatest importance to patients. However, very few patients (1–3 percent of eligible patients) are able to participate in pulmonary rehabilitation. Therefore, we need to develop and test different approaches that honor patients’ preferences and needs in our efforts to promote increased physical activity.
Objectives: To test the effectiveness of a patient-centered, physical activity coaching (PAC) program in a real-world healthcare system and measure outcomes of greatest importance to patients, such as staying out of the hospital, perception of support, and quality of life compared to standard care (SC).
Methods: From our electronic medical records system, we will identify 1,656 patients who were previously hospitalized for a COPD flare-up and randomize them to receive PAC or SC. SC patients will continue to have access to existing health services. PAC patients will receive SC plus the personalized 12-month PAC intervention, which includes baseline orientation and functional assessment, intensive coaching, and proactive professional and peer support. We will measure patients’ care experience and quality of life. We will also measure other health service use and clinical outcomes that can be obtained from patients’ health records. We will look at how different patient subgroups respond to PAC.
Patient Outcomes: Because staying out of the hospital is highly valued by patients and their families, the primary outcome will be number of hospitalizations.
Patient and Stakeholder Engagement: Over more than 12 months, we have engaged all key stakeholders including patients, clinicians, administrators, and high-level operations leadership in a series of gap analyses and planning for this research proposal. Input from a Patient Advisory Board has informed the development of this proposal. All stakeholders will participate in the planning and start-up phase, implementation, evaluation, and dissemination.
Anticipated Impact: A real-world trial of PAC for patients with COPD is unprecedented. If this study is successful, PAC could potentially provide patients and their families with an effective alternative that better meets their individual preferences and needs.
Results of This Project
Other Clinical Interventions
Other Health Services Interventions
Training and Education Interventions