COPD Discharge Bundle Delivered Alone or Enhanced Through a Care Coordinator

NCT03358771 | Completed

• 1 other identifier: Pro00065003
• Study Type: interventional
• Target: 3,710
• Locations: 1 country
• Sites: 5

Brief Summary

Chronic obstructive pulmonary disease (COPD) is a common, chronic progressive lung disease that is characterized by shortness of breath, activity limitation, and a predisposition to flare-ups resulting in frequent emergency department (ED) visits and hospitalizations. COPD flare-ups increase risks of disease progression and mortality and account for the greatest proportion of preventable hospitalizations among major chronic diseases. Evidence show that timely integrated disease management can prevent future COPD flare-ups and readmissions, but recent data indicate that appropriate follow-up after a COPD hospitalization is limited. To reduce this care gap, the investigators developed a discharge care bundle to help a patient that are being discharged from hospital or ED after COPD flare-up transition to community care. The aim of this study is to assess how effective and cost-effective is such bundle delivered alone or supported by the dedicated care manager. The investigators will be assessing reduction of ED and hospital readmission.

Conditions

Pulmonary Disease, Chronic Obstructive

Keywords

COPD; AECOPD; Discharge care bundle; Patient Care Bundles

Outcome Measures

Primary Outcomes (2)

• ED revisits

  Number of revisits

  30 days after discharge

• Hospital readmissions

  Number of readmissions

  30 days after discharge

Secondary Outcomes (15)

• ED revisits

  7 days after discharge

• ED revisits

  90 days after discharge

• ED revisits

  1 year after discharge

• Hospital readmission

  7 days after discharge

• Hospital readmission

  90 days after discharge

Study Arms (3)

Usual Care

NO INTERVENTION

During the initial stepped wedge phase, all sites will receive usual care. There is currently no standardized discharge care bundle for COPD in Alberta. Some electronic patient information sheets do exist; however, their content is general and use is limited. It is expected that a vast majority of patients will transition to the community on a sub-optimal medication regimen, with limited referral to additional outpatient programs and no formal follow-up organized with a primary care provider (e.g., "F/U prn" or "F/U with Fam MD").

COPD discharge care bundle

ACTIVE COMPARATOR

COPD discharge care bundle: 1. Ensure patient has demonstrated adequate inhaler technique 2. Send discharge summary to family physician office and arrange follow-up 3. Optimize and reconcile prescription of respiratory medications 4. Provide a written discharge management plan, and assess patient's and care giver's comprehension of discharge instructions 5. Refer to pulmonary rehabilitation 6. Screen for frailty and comorbid condition(s) 7. Assess smoking status, provide counseling and refer to smoking cessation program, where appropriate

Other: COPD discharge care bundle

COPD discharge care bundle & coordinator

EXPERIMENTAL

COPD discharge care bundle as listed for active comparator arm enhanced with care coordinator support.

Other: COPD discharge care bundle & coordinator

Interventions

COPD discharge care bundle OTHER

As a part of RHSCN quality improvement initiative, the elements of the COPD discharge bundle were integrated into a standardized COPD admission order set and are being implemented province-wide. The discharging physician/team will complete the COPD bundle (with reminders facilitated by clinical decision support tools) prior to patient discharge. A copy of the bundle is retained in the patient's medical record, and another copy is sent to the patient's primary care provider detailing the components of the bundle that were completed prior to discharge, and those still needing to be addressed. The patient will also receive a patient-focused discharge checklist detailing discharge bundle items

COPD discharge care bundle

COPD discharge care bundle & coordinator OTHER

The coordinator will be health professional associated with a Primary Care Network, ED or AHS with access to patient information. Patients will be informed that care coordinator may contact them for follow up after discharge. At 48-72 hours after hospital/ED discharge and then at intervals to be determined, the care coordinator will contact the patient by phone. The care coordinator will identify specific needs or problems that patient may have encountered after discharge, which could potentially affect the successful transition from acute to community care setting. Specifically, the care coordinator will seek information on any follow up with family doctor visit, pulmonary rehabilitation and smoking cessation referrals

COPD discharge care bundle & coordinator

Eligibility Criteria

• Age: 50 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Medical diagnosis of COPD;
• Male or female, 50 years of age and over, admitted to ED or hospital for an exacerbation of COPD. The age limit is imposed to reduce the chances of enrolling patients with asthma.
• Any stage of severity;
• Not being treated previously under the COPD care bundle

You may not qualify if:

• Patients with a diagnosis other than COPD will be excluded.

Sponsors & Collaborators

• University of Alberta: lead
• University of Calgary: collaborator
• Alberta Health services: collaborator
• Alberta Innovates Health Solutions: collaborator

Study Sites (5)

Foothills Medical Centre

Calgary, Alberta, Canada

Location

Rockyview General Hospital

Calgary, Alberta, Canada

Location

Royal Alexandra Hospital

Edmonton, Alberta, Canada

Location

University of Alberta Hospital

Edmonton, Alberta, Canada

Location

Red Deer Regional Hospital Centre

Red Deer, Alberta, T4N 4E7, Canada

Location

Related Publications (1)

• Atwood CE, Bhutani M, Ospina MB, Rowe BH, Leigh R, Deuchar L, Faris P, Michas M, Mrklas KJ, Graham J, Aceron R, Damant R, Green L, Hirani N, Longard K, Meyer V, Mitchell P, Tsai W, Walker B, Stickland MK. Optimizing COPD Acute Care Patient Outcomes Using a Standardized Transition Bundle and Care Coordinator: A Randomized Clinical Trial. Chest. 2022 Aug;162(2):321-330. doi: 10.1016/j.chest.2022.03.047. Epub 2022 Apr 9.

  PMID: 35405112 DERIVED

MeSH Terms

Conditions

Pulmonary Disease, Chronic Obstructive

Condition Hierarchy (Ancestors)

Lung Diseases, Obstructive; Lung Diseases; Respiratory Tract Diseases; Chronic Disease; Disease Attributes; Pathologic Processes; Pathological Conditions, Signs and Symptoms

Study Officials

• Michael K Stickland, PhD

  University of Alberta

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: TRIPLE
• Who Masked: PARTICIPANT, INVESTIGATOR, OUTCOMES ASSESSOR
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: CROSSOVER
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Professor

Study Record Dates

• First Submitted: November 21, 2017
• First Posted: December 2, 2017
• Study Start: March 1, 2017
• Primary Completion: December 30, 2019
• Study Completion: December 30, 2019
• Last Updated: May 5, 2021

Record last verified: 2021-05

Data Sharing

• IPD Sharing: Will not share

Locations

CA (5)