Does Outpatient Telephone Coaching Add to Hospital Quality Improvement Following Hospitalization for Acute Coronary Syndrome?
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Telephone counseling in chronic disease self-management is increasing, but has not been tested in studies that control for quality of medical care.
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.
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.
Seven hundred and nineteen patients admitted to one of five hospitals in two contiguous mid-Michigan communities enrolled; 525 completed baseline surveys.
We measured secondary prevention behaviors, physical functioning, and quality of life.
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physical activity (OR = 1.53; p = .01) during the first three months, with decline after active intervention was withdrawn.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.
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 WORDSclinical trials disease management guidelines chronic disease quality improvement patient-centered care acute coronary syndrome telephone counseling decision support techniques
Special thanks to Chrystal Price, MS, for data entry, Camille Proden, RN, BSN, community project manager, for supervision of field staff, study recruitment and medical record auditing, and to Cynthia Alderson (deceased) for project management. The sponsor had no role in the design and conduct of the study; collection, management, analysis, or interpretation of the data; preparation review or approval of the manuscript. Presented in part at: the Society for General Internal Medicine Annual Meeting, 2006.
Supported in part by an AHRQ R01 grant (HS10531), “Translating Research: Patient Decision Support/Coaching” (Dr. Margaret Holmes-Rovner, Principal Investigator). None of the authors receives compensation from any of the hospitals studied. No consultancies, honoraria, stock ownership, expert testimony, grants received, grants pending, patients pending, patients received or royalties or other relationships represent a conflict of interest for any of the authors.
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