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The E-Coach technology-assisted care transition system: a pragmatic randomized trial

  • Original Research
  • Published:
Translational Behavioral Medicine

Abstract

Care transitions from the hospital to home remain a vulnerable time for many patients, especially for those with heart failure (CHF) and chronic obstructive pulmonary disease (COPD). Despite regular use in chronic disease management, it remains unclear how technology can best support patients during their transition from the hospital. We sought to evaluate the impact of a technology-supported care transition support program on hospitalizations, days out of the community and mortality. Using a pragmatic randomized trial, we enrolled patients (511 enrolled, 478 analyzed) hospitalized with CHF/COPD to “E-Coach,” an intervention with condition-specific customization and in-hospital and post-discharge support by a care transition nurse (CTN), interactive voice response post-discharge calls, and CTN follow-up versus usual post-discharge care (UC). The primary outcome was 30-day rehospitalization. Secondary outcomes included (1) rehospitalization and death and (2) days in the hospital and out of the community. E-Coach and UC groups were similar at baseline except for gender imbalance (p = 0.02). After adjustment for gender, our primary outcome, 30-day rehospitalization rates did not differ between the E-Coach and UC groups (15.0 vs. 16.3 %, adjusted hazard ratio [95 % confidence interval]: 0.94 [0.60, 1.49]). However, in the COPD subgroup, E-Coach was associated with significantly fewer days in the hospital (0.5 vs. 1.6, p = 0.03). E-Coach, an IVR-augmented care transition intervention did not reduce rehospitalization. The positive impact on our secondary outcome (days in hospital) among COPD patients, but not in CHF, may suggest that E-Coach may be more beneficial among patients with COPD.

NIH trial registry number: NCT01135381

Trial Protocol: http://dx.doi.org/10.1016/j.cct.2012.08.007

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Acknowledgments

Contributors

Special thanks to Mr. Will Callans who played a key role in recruitment, retention, and assurance of data quality of this study and to Dr. Deborah Barnes for editing and preparing the revised manuscript for submission.

Prior presentations

E-Coaching: Interactive Voice Response (IVR)-Enhanced Care Transition Support for Complex Patients. AHRQ National Webinar: Leveraging Health Information Technology for Patient Empowerment. AHRQ National Resource Center for Health Information Technology April 8, 2010; Care Coordination and Care Transitions through Workflow Management. AHRQ Health IT Grantee and Contractor Meeting; Washington, DC; June 2–5, 2010.

Author information

Authors and Affiliations

  1. Division of Gerontology, Geriatrics and Palliative Care, University of Alabama at Birmingham (UAB), Birmingham, AL, USA

    Christine S. Ritchie MD, MSPH

  2. Division of Geriatrics, University of California San Francisco (UCSF), San Francisco, CA, USA

    Christine S. Ritchie MD, MSPH

  3. eHealth Quality Enhancement Research Initiative, Bedford VAMC, Bedford, MA, USA

    Thomas K. Houston MD, MPH

  4. Division of Health Informatics and Implementation Science, University of Massachusetts Medical School, 368, Plantation Street, Worcester, MA, 01605, USA

    Thomas K. Houston MD, MPH

  5. Birmingham VA Medical Center, Birmingham, AL, USA

    Joshua S. Richman MD, PhD

  6. Southern Research Institute, Birmingham, AL, USA

    Heather J. Sobko PhD

  7. Health Informatics, Department of Health Services Administration, UAB School of Health Professions, Birmingham, AL, USA

    Eta S. Berner EdD

  8. Division of General Internal Medicine, UAB Department of Medicine, Birmingham, AL, USA

    Benjamin B. Taylor MD

  9. Geriatric Research, Education, and Clinical Center, VA Tennessee and Valley Healthcare System and Section of Hospital Medicine, Vanderbilt University, Nashville, TN, USA

    Amanda H. Salanitro MD

  10. UAB School of Public Health, Birmingham, AL, USA

    Julie L. Locher PhD

Authors
  1. Christine S. Ritchie MD, MSPH
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  2. Thomas K. Houston MD, MPH
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  3. Joshua S. Richman MD, PhD
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  4. Heather J. Sobko PhD
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  5. Eta S. Berner EdD
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  6. Benjamin B. Taylor MD
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  7. Amanda H. Salanitro MD
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  8. Julie L. Locher PhD
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Corresponding author

Correspondence to Thomas K. Houston MD, MPH.

Ethics declarations

Research involving human participants

Ethical approval for the study was granted by the University of Alabama at Birmingham Institutional Review Board. All subjects (or their proxies) provided written informed consent for study participation.

Conflict of interest

The authors declare that they have no conflict of interests.

Funding

This study was in part supported by the Agency for Healthcare Research and Quality of Care of Complex Patients grant (R18-HS017786-02).

Additional information

Implication

Policymakers: The benefit of post-discharge support in COPD patients suggests different needs from those with heart failure and supports the need for personalized post-discharge care approaches as part of population health policies.

Researchers: Research is still needed to better understand which components of the IVR may be influencing hospital readmission rates so that systems can be further refined for optimal outcomes.

Practitioners: To optimize care after discharge, a tiered approach may be required with patient activation/coaching for those with moderate needs (COPD) and active medical support and guidance added to coaching for particularly complex patients (CHF).

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Ritchie, C.S., Houston, T.K., Richman, J.S. et al. The E-Coach technology-assisted care transition system: a pragmatic randomized trial. Behav. Med. Pract. Policy Res. 6, 428–437 (2016). https://doi.org/10.1007/s13142-016-0422-8

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  • DOI: https://doi.org/10.1007/s13142-016-0422-8

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