title: Can a supported self-management program for COPD upon hospital discharge reduce readmissions? A randomized controlled trial.
abstract: BACKGROUND
  Patients with COPD experience exacerbations that may require hospitalization. Patients do not always feel supported upon discharge and frequently get readmitted. A Self-management Program of Activity, Coping, and Education for COPD (SPACE for COPD), a brief self-management program, may help address this issue.
  
  
  OBJECTIVE
  To investigate if SPACE for COPD employed upon hospital discharge would reduce readmission rates at 3 months, compared with usual care.
  
  
  METHODS
  This is a prospective, single-blinded, two-center trial (ISRCTN84599369) with participants admitted for an exacerbation, randomized to usual care or SPACE for COPD. Measures, including health-related quality of life and exercise capacity, were taken at baseline (hospital discharge) and at 3 months. The primary outcome measure was respiratory readmission at 3 months.
  
  
  RESULTS
  Seventy-eight patients were recruited (n=39 to both groups). No differences were found in readmission rates or mortality at 3 months between the groups. Ten control patients were readmitted within 30 days compared to five patients in the intervention group (P>0.05). Both groups significantly improved their exercise tolerance and Chronic Respiratory Questionnaire (CRQ-SR) results, with between-group differences approaching statistical significance for CRQ-dyspnea and CRQ-emotion, in favor of the intervention. The "Ready for Home" survey revealed that patients receiving the intervention reported feeling better able to arrange their life to cope with COPD, knew when to seek help about feeling unwell, and more often took their medications as prescribed, compared to usual care (P<0.05).
  
  
  CONCLUSIONS
  SPACE for COPD did not reduce readmission rates at 3 months above that of usual care. However, encouraging results were seen in secondary outcomes for those receiving the intervention. Importantly, SPACE for COPD appears to be safe and may help prevent readmission with 30 days.
authors.affiliation: Department of Respiratory Medicine, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK; Faculty of Health and Life Sciences, Coventry University, Coventry, UK.
authors.forename: Vicki
authors.initials: V
authors.lastname: Johnson-Warrington
authors.affiliation: Warwick Medical School, University of Warwick, Coventry, UK.
authors.forename: Karen
authors.initials: K
authors.lastname: Rees
authors.affiliation: Department of Respiratory Medicine, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.
authors.forename: Colin
authors.initials: C
authors.lastname: Gelder
authors.affiliation: Centre for Exercise and Rehabilitation Science, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK.
authors.forename: Mike D
authors.initials: MD
authors.lastname: Morgan
authors.affiliation: Faculty of Health and Life Sciences, Coventry University, Coventry, UK; Centre for Exercise and Rehabilitation Science, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK.
authors.forename: Sally J
authors.initials: SJ
authors.lastname: Singh
mesh_terms: D000223:Adaptation, Psychological; D000368:Aged; D018450:Disease Progression; D004739:England; D017079:Exercise Tolerance; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D053208:Kaplan-Meier Estimate; D008168:Lung / Q000503:physiopathology*; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010351:Patient Discharge; D010353:Patient Education as Topic; D010359:Patient Readmission; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D011788:Quality of Life; D020127:Recovery of Function; D012307:Risk Factors; D012648:Self Care / Q000379:methods*; D016037:Single-Blind Method; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome
keywords: COPD exacerbations; emphysema; exercise; pulmonary rehabilitation; self-management