Does Outpatient Telephone Coaching Add to Hospital Quality Improvement Following Hospitalization for Acute Coronary Syndrome?

Center for Ethics, C203 E. Fee Hall, Michigan State University College of Human Medicine, East Lansing, MI 48824, USA.
Journal of General Internal Medicine (Impact Factor: 3.42). 08/2008; 23(9):1464-70. DOI: 10.1007/s11606-008-0710-1
Source: PubMed


Telephone counseling in chronic disease self-management is increasing, but has not been tested in studies that control for quality of medical care.
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.
Patient-level randomized trial of hospital quality improvement (QI-only) versus quality improvement plus brief telephone coaching in three months post-hospitalization (QI-plus). Data: medical record, state vital records, patient surveys (baseline, three and eight months post-hospitalization). Analysis: pooled-time series generalized estimating equations to analyze repeated measures; intention-to-treat analysis.
Seven hundred and nineteen patients admitted to one of five hospitals in two contiguous mid-Michigan communities enrolled; 525 completed baseline surveys.
We measured secondary prevention behaviors, physical functioning, and quality of life.
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physical activity (OR = 1.53; p = .01) during the first three months, with decline after active intervention was withdrawn.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.
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.

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Available from: Margaret Holmes-Rovner
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    • "Nine of the included studies were conducted in Canada [13], [16], [20], [30], [31], [32], [33], [34], [35] 8 in Australia[17], [25]–[29], [37], [38], 5 in the United States of America[14], [21]–[23], [38] 3 in Europe [18], [19], [24] and 1 in Iran [15]. Thirteen studies had longer than 6 months of follow-up [19], [21], [22], [24], [25], [26], [28], [29], [30], [31]–[33], [38]. Seven studies reported less than 6 months of follow-up [15]–[17], [20], [27], [34], [35] and 6 reported outcomes at 6 months [13], [14], [18], [23], [36], [37]. "
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    ABSTRACT: Cardiac rehabilitation is offered to individuals after cardiac events to aid recovery and reduce the likelihood of further cardiac illness. However, patient participation remains suboptimal and the provision of high quality care to an expanding population of patients with chronic heart conditions is becoming increasingly difficult. A systematic review and meta-analysis was conducted to determine the effect of telephone support interventions compared with standard post-discharge care on coronary artery disease patient outcomes. The Cochrane Library, MEDLINE, EMBASE, and CINAHL were searched and randomized controlled trials that directly compared telephone interventions with standard post-discharge care in adults following a myocardial infarction or a revascularization procedure were included. Study selection, data extraction and quality assessment were completed independently by two reviewers. Where appropriate, outcome data were combined and analyzed using a random effects model. For each dichotomous outcome, odds ratios (OR) and 95% confidence intervals (CI) were derived for each outcome. For continuous outcomes, weighted mean differences (WMD) and standardized mean differences (SMD) and 95% CI were calculated. 26 studies met the inclusion criteria. No difference was observed in mortality between the telephone group and the group receiving standard care OR 1.12 (0.71, 1.77). The intervention was significantly associated with fewer hospitalizations than the comparison group OR 0.62 (0.40, 0.97). Significantly more participants in the telephone group stopped smoking OR 1.32 (1.07, 1.62); had lower systolic blood pressure WMD -0.22 (-0.40, -0.04); lower depression scores SMD -0.10 (-0.21, -0.00); and lower anxiety scores SMD -0.14 (-0.24, -0.04). However, no significant difference was observed for low-density lipoprotein levels WMD -0.10 (-0.23, 0.03). Compared to standard post-discharge care, regular telephone support interventions may help reduce feelings of anxiety and depression as well as, improve systolic blood pressure control and the likelihood of smoking cessation.
    Full-text · Article · May 2014 · PLoS ONE
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    • "The intervention was designed to improve patients’ health behaviors within a post-discharge quality improvement program. [29] For detailed information, see Holmes-Rovner et al [29]. "
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    ABSTRACT: The search for a reliable, valid and cost-effective comorbidity risk adjustment method for outcomes research continues to be a challenge. The most widely used tool, the Charlson Comorbidity Index (CCI) is limited due to frequent missing data in medical records and administrative data. Patient self-report data has the potential to be more complete but has not been widely used. The purpose of this study was to evaluate the performance of the Self-Administered Comorbidity Questionnaire (SCQ) to predict functional capacity, quality of life (QOL) health outcomes compared to CCI medical records data. An SCQ-score was generated from patient interview, and the CCI score was generated by medical record review for 525 patients hospitalized for Acute Coronary Syndrome (ACS) at baseline, three months and eight months post-discharge. Linear regression models assessed the extent to which there were differences in the ability of comorbidity measures to predict functional capacity (Activity Status Index [ASI] scores) and quality of life (EuroQOL 5D [EQ5D] scores). The CCI (R2 = 0.245; p = 0.132) did not predict quality of life scores while the SCQ self-report method (R2 = 0.265; p < 0.0005) predicted the EQ5D scores. However, the CCI was almost as good as the SCQ for predicting the ASI scores at three and six months and performed slightly better in predicting ASI at eight-month follow up (R2 = 0.370; p < 0.0005 vs. R2 = 0.358; p < 0.0005) respectively. Only age, gender, family income and Center for Epidemiologic Studies-Depression (CESD) scores showed significant association with both measures in predicting QOL and functional capacity. Although our model R-squares were fairly low, these results show that the self-report SCQ index is a good alternative method to predict QOL health outcomes when compared to a CCI medical record score. Both measures predicted physical functioning similarly. This suggests that patient self-reported comorbidity data can be used for predicting physical functional capacity and QOL and can serve as a reliable risk adjustment measure. Self-report comorbidity data may provide a cost-effective alternative method for risk adjustment in clinical research, health policy and organizational improvement analyses. Trial registration Clinical NCT00416026
    Full-text · Article · Nov 2012 · BMC Health Services Research
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    • "Although some counter-examples exist [1] [2] [3], telephone counseling has been generally successful in promoting medication adherence, healthy diet, and other lifestyle modifications among patients with high blood pressure (HBP) [4] [5] [6] and cardiovascular disease [7] [8]. The advantages of telephone-delivered interventions include: ease of implementation [9] [10]; cost-effectiveness [10]; and the capacity to reach a large group of people [11]. "
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    ABSTRACT: Nurse telephone counseling can improve the management of chronic conditions, but the effectiveness of this approach in underserved populations is unclear. This study evaluated the use of bilingual nurse-delivered telephone counseling in Korean Americans (KAs) participating in a community-based intervention trial to improve management of hypertension. KAs were randomized to receive 12 months of hypertension-related telephone counseling that was more intensive (bi-weekly) or less intensive (monthly). Counseling logs were kept for 360 KAs who completed the pre- and post-intervention evaluations. The overall success rate for the intervention was 80.3%. The level of success was significantly influenced by the dose of counseling, employment status, and years of US residence. Over the 12-month counseling period, both groups showed improvement with regard to medication-taking, alcohol consumption, and exercise but not smoking, with no significant group differences. Bilingual telephone counseling could reach monolingual KAs and improve their hypertension management behavior. Bilingual nurse telephone counseling may have wide applicability, serving as an effective means of disseminating evidence-based chronic disease management guidelines to a linguistically isolated community with limited health resources and information.
    Full-text · Article · Nov 2009 · Patient Education and Counseling
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