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.

Keywords: Care transitions; Self-management; Telehealth.

Figures

Fig. 1

E-Coach participant flow diagram

Fig. 2

Kaplan-Meier curves demonstrating time to rehospitalization or death in the E-Coach intervention or usual care control groups in the first 30 days, stratified by condition. In the congestive heart failure (CHF) group (left panel), there was a nonsignificant trend toward faster time to rehospitalization or death in the E-Coach intervention group (dotted line) versus the usual care control group (solid line) over the first 20 days with no difference between the groups by 30 days. In the chronic obstructive pulmonary disease (COPD) group (right panel), there was a nonsignificant trend toward less rehospitalization and mortality in the E-Coach group (dotted line) than the usual care group (solid line)