Does outpatient telephone coaching add to hospital quality improvement following hospitalization for acute coronary syndrome?
Does outpatient telephone coaching add to hospital quality improvement following hospitalization for acute coronary syndrome?
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DOI：
10.1007/s11606-008-0710-1
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发表时间：
2008-09-01
影响因子：
5.7
通讯作者：
Dunn, Susan L.
中科院分区：
文献类型：
--
作者：
Holmes-Rovner, Margaret;Stommel, Manfred;Dunn, Susan L.
背景：慢性病自我管理中的电话咨询正在增加，但尚未在控制医疗质量的研究中进行测试。目的：测试六次门诊电话咨询干预的有效性，以改善急性冠脉综合征（ACS）患者出院后的二级预防（行为、药物），以及对出院后 8 个月身体功能和生活质量的影响。设计：医院质量改进（仅 QI）与质量的患者级随机试验住院后三个月内的改善加上简短的电话辅导（QI-plus）。数据：医疗记录、州重要记录、患者调查（基线、出院后三个月和八个月）。分析：用于分析重复测量的合并时间序列广义估计方程；意向治疗分析。参与者：入组的密歇根州中部两个相邻社区的五家医院之一收治的 719 名患者； 525 名已完成基线调查。测量：我们测量了二级预防行为、身体机能和生活质量。结果：QI+ 患者在前三个月表现出较高的自我报告体力活动（OR=1.53；p=.01），但在主动干预撤回后有所下降。 3 个月或 8 个月时戒烟和药物使用没有差异； 8 个月时功能状态和生活质量没有差异。结论：ACS 住院后电话辅导对于实现短期而非长期生活方式行为改变具有一定效果。以前在初级保健中显示的积极结果并没有转移到独立的电话咨询作为住院后护理的辅助手段。
BACKGROUND: Telephone counseling in chronic disease self-management is increasing, but has not been tested in studies that control for quality of medical care.OBJECTIVE: To test the effectiveness of a six-session outpatient telephone-based counseling intervention to improve secondary prevention (behaviors, medication) in patients with acute coronary syndrome (ACS) following discharge from hospital, and impact on physical functioning and quality of life at 8 months post-discharge.DESIGN: Patient-level randomized trial of hospital quality improvement (QI-only) versus quality improvement plus brief telephone coaching in three months post-hospitalization (QI-plus). Data: medical record, state vital records, patient surveys (baseline, three and eight months post-hospitalization). Analysis: pooled-time series generalized estimating equations to analyze repeated measures; intention-to-treat analysis.PARTICIPANTS: Seven hundred and nineteen patients admitted to one of five hospitals in two contiguous mid-Michigan communities enrolled; 525 completed baseline surveys.MEASUREMENTS: We measured secondary prevention behaviors, physical functioning, and quality of life.RESULTS: QI-plus patients showed higher self-reported physical activity (OR=1.53; p=.01) during the first three months, with decline after active intervention was withdrawn. Smoking cessation and medication use were not different at 3 or 8 months; functional status and quality of life were not different at 8 months.CONCLUSIONS: Telephone coaching post-hospitalization for ACS was modestly effective in accomplishing short-term, but not long-term life-style behavior change. Previous positive results shown in primary care did not transfer to free-standing telephone counseling as an adjunct to care following hospitalization.