Does Outpatient Telephone Coaching Add to Hospital Quality Improvement Following Hospitalization for Acute Coronary Syndrome?

  • Margaret Holmes-Rovner
  • Manfred Stommel
  • William D. Corser
  • Adesuwa Olomu
  • Jodi Summers Holtrop
  • Azfar Siddiqi
  • Susan L. Dunn
Original Article

DOI: 10.1007/s11606-008-0710-1

Cite this article as:
Holmes-Rovner, M., Stommel, M., Corser, W.D. et al. J GEN INTERN MED (2008) 23: 1464. doi:10.1007/s11606-008-0710-1

Abstract

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physical activity (OR = 1.53; p = .01) during the first three months, with decline after active intervention was withdrawn.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.

KEY WORDS

clinical trialsdisease managementguidelineschronic diseasequality improvementpatient-centered careacute coronary syndrometelephone counselingdecision support techniques

Copyright information

© Society of General Internal Medicine 2008

Authors and Affiliations

  • Margaret Holmes-Rovner
    • 1
    • 2
  • Manfred Stommel
    • 3
  • William D. Corser
    • 3
  • Adesuwa Olomu
    • 2
  • Jodi Summers Holtrop
    • 4
  • Azfar Siddiqi
    • 3
  • Susan L. Dunn
    • 5
  1. 1.Center for Ethics, C203 E. Fee HallMichigan State University College of Human MedicineEast LansingUSA
  2. 2.Department of MedicineCollege of Human MedicineEast LansingUSA
  3. 3.College of NursingMichigan State UniversityEast LansingUSA
  4. 4.Department of Family MedicineCollege of Human MedicineEast LansingUSA
  5. 5.Department of NursingHope CollegeHollandUSA