title: The E-Coach technology-assisted care transition system: a pragmatic randomized trial.
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: NCT01135381Trial Protocol: http://dx.doi.org/ 10.1016/j.cct.2012.08.007.
authors.affiliation: Division of Gerontology, Geriatrics and Palliative Care, University of Alabama at Birmingham (UAB), Birmingham, AL, USA.|Division of Geriatrics, University of California San Francisco (UCSF), San Francisco, CA, USA.
authors.forename: Christine S
authors.initials: CS
authors.lastname: Ritchie
authors.affiliation: eHealth Quality Enhancement Research Initiative, Bedford VAMC, Bedford, MA, USA. Thomas.Houston@umassmed.edu.|Division of Health Informatics and Implementation Science, University of Massachusetts Medical School, 368, Plantation Street, Worcester, MA, 01605, USA. Thomas.Houston@umassmed.edu.
authors.forename: Thomas K
authors.initials: TK
authors.lastname: Houston
authors.affiliation: Birmingham VA Medical Center, Birmingham, AL, USA.
authors.forename: Joshua S
authors.initials: JS
authors.lastname: Richman
authors.affiliation: Southern Research Institute, Birmingham, AL, USA.
authors.forename: Heather J
authors.initials: HJ
authors.lastname: Sobko
authors.affiliation: Health Informatics, Department of Health Services Administration, UAB School of Health Professions, Birmingham, AL, USA.
authors.forename: Eta S
authors.initials: ES
authors.lastname: Berner
authors.affiliation: Division of General Internal Medicine, UAB Department of Medicine, Birmingham, AL, USA.
authors.forename: Benjamin B
authors.initials: BB
authors.lastname: Taylor
authors.affiliation: Geriatric Research, Education, and Clinical Center, VA Tennessee and Valley Healthcare System and Section of Hospital Medicine, Vanderbilt University, Nashville, TN, USA.
authors.forename: Amanda H
authors.initials: AH
authors.lastname: Salanitro
authors.affiliation: UAB School of Public Health, Birmingham, AL, USA.
authors.forename: Julie L
authors.initials: JL
authors.lastname: Locher
mesh_terms: D000368:Aged; D002908:Chronic Disease; D005260:Female; D006333:Heart Failure / Q000628:therapy; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018670:Monitoring, Ambulatory / Q000379:methods; D010351:Patient Discharge; D010360:Patient Transfer / Q000379:methods*; D029424:Pulmonary Disease, Chronic Obstructive / Q000401:mortality / Q000628:therapy; D012648:Self Care; D017216:Telemedicine / Q000379:methods*
keywords: Care transitions; Self-management; Telehealth