title: Health Coaching and Chronic Obstructive Pulmonary Disease Rehospitalization. A Randomized Study.
abstract: Hospital readmission for chronic obstructive pulmonary disease (COPD) has attracted attention owing to the burden to patients and the health care system. There is a knowledge gap on approaches to reducing COPD readmissions.
  
  
  
  To determine the effect of comprehensive health coaching on the rate of COPD readmissions.
  
  
  
  A total of 215 patients hospitalized for a COPD exacerbation were randomized at hospital discharge to receive either (1) motivational interviewing-based health coaching plus a written action plan for exacerbations (the use of antibiotics and oral steroids) and brief exercise advice or (2) usual care.
  
  
  
  We evaluated the rate of COPD-related hospitalizations during 1 year of follow-up. The absolute risk reductions of COPD-related rehospitalization in the health coaching group were 7.5% (P = 0.01), 11.0% (P = 0.02), 11.6% (P = 0.03), 11.4% (P = 0.05), and 5.4% (P = 0.24) at 1, 3, 6, 9, and 12 months, respectively, compared with the control group. The odds ratios for COPD hospitalization in the intervention arm compared with the control arm were 0.09 (95% confidence interval [CI], 0.01-0.77) at 1 month postdischarge, 0.37 (95% CI, 0.15-0.91) at 3 months postdischarge, 0.43 (95% CI, 0.20-0.94) at 6 months postdischarge, and 0.60 (95% CI, 0.30-1.20) at 1 year postdischarge. The missing value rate for the primary outcome was 0.4% (one patient). Disease-specific quality of life improved significantly in the health coaching group compared with the control group at 6 and 12 months, based on the Chronic Respiratory Disease Questionnaire emotional score (emotion and mastery domains) and physical score (dyspnea and fatigue domains) (P < 0.05). There were no differences between groups in measured physical activity at any time point.
  
  
  
  Health coaching may represent a feasible and possibly effective intervention designed to reduce COPD readmissions. Clinical trial registered with www.clinicaltrials.gov (NCT01058486).
authors.affiliation: 1 Mindful Breathing Laboratory, Division of Pulmonary and Critical Care Medicine.
authors.forename: Roberto
authors.initials: R
authors.lastname: Benzo
authors.affiliation: 2 Department of Psychology, and.
authors.forename: Kristin
authors.initials: K
authors.lastname: Vickers
authors.affiliation: 3 Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Novotny
authors.affiliation: 4 University of Iowa Hospitals & Clinics, Iowa City, Iowa.
authors.forename: Sharon
authors.initials: S
authors.lastname: Tucker
authors.affiliation: 1 Mindful Breathing Laboratory, Division of Pulmonary and Critical Care Medicine.
authors.forename: Johanna
authors.initials: J
authors.lastname: Hoult
authors.affiliation: 5 HealthPartners Institute for Education and Research, Bloomington, Minnesota.
authors.forename: Pamela
authors.initials: P
authors.lastname: Neuenfeldt
authors.affiliation: 6 Academic Health Center, University of Minnesota, Minneapolis, Minnesota; and.
authors.forename: John
authors.initials: J
authors.lastname: Connett
authors.affiliation: 7 Stanford Patient Education Research Center, Palo Alto, California.
authors.forename: Kate
authors.initials: K
authors.lastname: Lorig
authors.affiliation: 5 HealthPartners Institute for Education and Research, Bloomington, Minnesota.
authors.forename: Charlene
authors.initials: C
authors.lastname: McEvoy
mesh_terms: D000368:Aged; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D008297:Male; D000071252:Mentoring / Q000379:methods; D062405:Motivational Interviewing / Q000379:methods*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D029424:Pulmonary Disease, Chronic Obstructive / Q000517:prevention & control* / Q000523:psychology; D011788:Quality of Life
keywords: chronic obstructive pulmonary disease; communication skills; health coaching; hospitalizations; quality of life