title: Randomized trial of pragmatic education for low-risk COPD patients: impact on hospitalizations and emergency department visits.
abstract: BACKGROUND
  Most interventions aimed at reducing hospitalizations and emergency department (ED) visits in patients with chronic obstructive pulmonary disease (COPD) have employed resource-intense programs in high-risk individuals. Although COPD is a progressive disease, little is known about the effectiveness of proactive interventions aimed at preventing hospitalizations and ED visits in the much larger population of low-risk (no known COPD-related hospitalizations or ED visits in the prior year) patients, some of whom will eventually become high-risk.
  
  
  METHODS
  We tested the effect of a simple educational and self-efficacy intervention (n = 2243) versus usual care (n = 2182) on COPD/breathing-related ED visits and hospitalizations in a randomized study of low-risk patients at three Veterans Affairs (VA) medical centers in the upper Midwest. Administrative data was used to track VA admissions and ED visits. A patient survey was used to determine health-related events outside the VA.
  
  
  RESULTS
  Rates of COPD-related VA hospitalizations in the education and usual care group were not significantly different (3.4 versus 3.6 admissions per 100 person-years, respectively; 95% CI of difference -1.3 to 1.0, P = 0.77). The much higher patient-reported rates of non-VA hospitalizations for breathing-related problems were lower in the education group (14.0 versus 19.0 per 100 person-years; 95% CI -8.6 to -1.4, P = 0.006). Rates of COPD-related VA ED visits were not significantly different (6.8 versus 5.3; 95% CI -0.1 to 3.0, P = 0.07), nor were non-VA ED visits (32.4 versus 36.5; 95% CI -9.3 to 1.1, P = 0.12). All-cause VA admission and ED rates did not differ. Mortality rates (6.9 versus 8.3 per 100 person-years, respectively; 95% CI -3.0 to 0.4, P = 0.13) did not differ.
  
  
  CONCLUSIONS
  An educational intervention that is practical for large numbers of low-risk patients with COPD may reduce the rate of breathing-related hospitalizations. Further research that more closely tracks hospitalizations to non-VA facilities is needed to confirm this finding.
authors.affiliation: University of Wisconsin Hospital and Clinics, Madison, WI, USA.
authors.forename: Haamid H
authors.initials: HH
authors.lastname: Siddique
authors.forename: Raymond H
authors.initials: RH
authors.lastname: Olson
authors.forename: Connie M
authors.initials: CM
authors.lastname: Parenti
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Rector
authors.forename: Michael
authors.initials: M
authors.lastname: Caldwell
authors.forename: Naresh A
authors.initials: NA
authors.lastname: Dewan
authors.forename: Kathryn L
authors.initials: KL
authors.lastname: Rice
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006040:Goals; D019538:Health Care Surveys; D006268:Health Facilities; D007722:Health Knowledge, Attitudes, Practice; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D012307:Risk Factors; D020377:Self Efficacy; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D014493:United States Department of Veterans Affairs
keywords: chronic obstructive pulmonary disease; disease management; education; self-efficacy