title: Does outpatient telephone coaching add to hospital quality improvement following hospitalization for acute coronary syndrome?
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.
  
  
  METHODS
  Patient-level randomized trial of hospital quality improvement (QI-only) versus quality improvement plus brief telephone coaching in three months post-hospitalization (QI-plus).
  
  
  METHODS
  medical record, state vital records, patient surveys (baseline, three and eight months post-hospitalization).
  
  
  METHODS
  pooled-time series generalized estimating equations to analyze repeated measures; intention-to-treat analysis.
  
  
  METHODS
  Seven hundred and nineteen patients admitted to one of five hospitals in two contiguous mid-Michigan communities enrolled; 525 completed baseline surveys.
  
  
  METHODS
  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physical activity (OR = 1.53; p = .01) during the first three months, with decline after active intervention was withdrawn.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.
authors.affiliation: Center for Ethics, C203 E. Fee Hall, Michigan State University College of Human Medicine, East Lansing, MI 48824, USA. mholmes@msu.edu
authors.forename: Margaret
authors.initials: M
authors.lastname: Holmes-Rovner
authors.forename: Manfred
authors.initials: M
authors.lastname: Stommel
authors.forename: William D
authors.initials: WD
authors.lastname: Corser
authors.forename: Adesuwa
authors.initials: A
authors.lastname: Olomu
authors.forename: Jodi Summers
authors.initials: JS
authors.lastname: Holtrop
authors.forename: Azfar
authors.initials: A
authors.lastname: Siddiqi
authors.forename: Susan L
authors.initials: SL
authors.lastname: Dunn
mesh_terms: D000203:Activities of Daily Living; D054058:Acute Coronary Syndrome / Q000628:therapy*; D000368:Aged; D037001:Directive Counseling; D005260:Female; D015438:Health Behavior; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D011788:Quality of Life; D017216:Telemedicine