Health Coaching and Chronic Obstructive Pulmonary Disease Rehospitalization
Health Coaching and Chronic Obstructive Pulmonary Disease Rehospitalization
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DOI：
10.1164/rccm.201512-2503oc
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发表时间：
2016-09-15
影响因子：
24.7
通讯作者：
McEvoy, Charlene
中科院分区：
文献类型：
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作者：
Benzo, Roberto;Vickers, Kristin;McEvoy, Charlene
理论基础：由于患者和医疗保健系统的负担，慢性阻塞性肺疾病(COPD)的再次住院引起了人们的关注。目的：确定综合健康指导对COPD再住院率的影响。方法：将215例COPD急性加重期患者在出院时随机分为两组：(1)以激励性访谈为基础的健康指导加针对病情加重的书面行动计划(使用抗生素和口服类固醇)和简短的运动建议；(2)常规护理。1、3、6、9、12个月健康训练组COPD相关再住院的绝对风险比对照组分别降低7.5%(P=0.01)、11.0%(P=0.02)、11.6%(P=0.03)、11.4%(P=0.05)、5.4%(P=0.24)。与对照组相比，干预组COPD住院的优势比在出院后1个月为0.09(95%可信区间，0.01-0.77)，出院3个月为0.37(95%可信区间，0.15-0.91)，出院6个月为0.43(95%可信区间，0.20-0.94)，1年为0.60(95%可信区间，0.30-1.20)。主要结果的缺失率为0.4%(1例患者)。根据慢性呼吸系统疾病问卷情感评分(情绪和掌握领域)和身体评分(呼吸困难和疲劳领域)，健康教练组在6个月和12个月时比对照组显著改善疾病特有的生活质量(P<；0.05)。结论：健康指导可能是一种可行的、可能有效的干预措施，旨在减少COPD的再入院。
Rationale: Hospital readmission for chronic obstructive pulmonary disease (COPD) has attracted attention owing to the burden to patients and the health care system. There is a knowledge gap on approaches to reducing COPD readmissions.Objectives: To determine the effect of comprehensive health coaching on the rate of COPD readmissions.Methods: A total of 215 patients hospitalized for a COPD exacerbation were randomized at hospital discharge to receive either (1) motivational interviewing-based health coaching plus a written action plan for exacerbations (the use of antibiotics and oral steroids) and brief exercise advice or (2) usual care.Measurements and Main Results: We evaluated the rate of COPD-related hospitalizations during 1 year of follow-up. The absolute risk reductions of COPD-related rehospitalization in the health coaching group were 7.5% (P = 0.01), 11.0% (P = 0.02); 11.6% (P = 0.03), 11.4% (P = 0.05), and 5.4% (P = 0.24) at 1, 3, 6, 9, and 12 months, respectively, compared with the control group. The odds ratios for COPD hospitalization in the intervention arm compared with the control arm were 0.09 (95% confidence interval [CI], 0.01-0.77) at 1 month postdischarge, 0.37 (95% CI, 0.15-0.91) at 3 months postdischarge, 0.43 (95% CI, 0.20-0.94) at 6 months postdischarge, and 0.60 (95% CI, 0.30-1.20) at 1 year postdischarge. The missing value rate for the primary outcome was 0.4% (one patient). Disease-specific quality of life improved significantly in the health coaching group compared with the control group at 6 and 12 months, based on the Chronic Respiratory Disease Questionnaire emotional score (emotion and mastery domains) and physical score (dyspnea and fatigue domains) (P < 0.05). There were no differences between groups in measured physical activity at any time point.Conclusions: Health coaching may represent a feasible and possibly effective intervention designed to reduce COPD readmissions.