Please select the arm or intervention descriptions that belong to the clinical trial below.
Title: CSP #560 - Bronchitis and Emphysema Advice and Training to Reduce Hospitalization (BREATH)
Brief Summary: EXECUTIVE SUMMARY:

Purpose: To evaluate the efficacy and cost-effectiveness of a novel intervention incorporating self-management education, an action plan, and case-management to decrease the risk of hospitalizations due to chronic obstructive pulmonary disease (COPD) among veterans with severe COPD.

Hypotheses:

Primary Hypothesis:

Veterans with COPD who receive a self-management program incorporating education sessions, development of an action plan, and case-management will have a decreased risk of COPD hospitalization compared to standardized COPD care.

Primary Objective:

In an intent-to-treat analysis, determine the efficacy of a comprehensive self-management program for reducing the risk of COPD hospitalization in veterans with severe COPD in comparison to patients receiving standardized COPD care.

Secondary Hypotheses:

Compared with standardized COPD care, veterans with COPD who receive a comprehensive self-management intervention will have: A) decreased health-related costs resulting from decreased hospitalizations and outpatient utilization, B) decreased hospitalization rates and average length of stay due to both COPD and all-cause admissions, and C) improvement in a set of outcomes including mortality, health-related quality of life, medication adherence, patient satisfaction, disease knowledge, skill acquisition and self-efficacy.

Secondary Objectives:

To evaluate the healthcare costs, hospitalization days, mortality, adherence, and health outcomes of a comprehensive self-management program compared to standardized COPD care among patients with severe COPD measured by:

A)Healthcare-related costs B)Health services use due to COPD and to all causes C)Clinical outcome measures

1. Mortality
2. Health-related quality of life measured by generic and COPD-specific measures
3. Patient satisfaction
4. Medication adherence
5. Disease knowledge, skill acquisition and self-efficacy

In the proposed study, 960 veterans with severe COPD hospitalized in the previous year will be randomly assigned to either a comprehensive case management program or standardized COPD care. The comprehensive group will receive an initial, intense education program with development of an action plan, and regular telephone contacts by a case manager in addition to standardized COPD care. Patients allocated to the control arm will receive standardized care that incorporates guideline-based recommendations including influenza vaccination, a short-acting bronchodilator, and either a long-acting bronchodilator or inhaled corticosteroid inhaler.

The study will be conducted in 2 phases, a 12-month feasibility study conducted at 6 VA sites followed by the full study in which an additional 8 sites will enroll patients over the next 24 months. As a result, 180 patients will be initially enrolled in the feasibility study over the first year and the remaining 780 patients will be enrolled in the second and third years of the study when the full study is implemented. Subjects will be followed until the completion of the study, for at least one, and up to four years. The primary outcome is time to first COPD hospitalization.


Options:
A: Arm Label: Intervention; Type: EXPERIMENTAL; Interventions: Behavioral: oral education & written tips for remembering medications, Device: pill box, Device: pocket medication card, Behavioral: sharing information with community pharmacist, Behavioral: Medication use evaluations by community pharmacist, Behavioral: informing physician if patient has stopped a medication, Behavioral: Routine discharge counseling, Other: Letter to physician/discharge summary | Arm Label: Usual Care; Type: ACTIVE_COMPARATOR; Interventions: Behavioral: Routine discharge counseling, Other: Letter to physician/discharge summary | Intervention Type: BEHAVIORAL; Name: oral education & written tips for remembering medications; Assigned to Arm(s): Intervention | Intervention Type: DEVICE; Name: pill box; Assigned to Arm(s): Intervention | Intervention Type: DEVICE; Name: pocket medication card; Assigned to Arm(s): Intervention | Intervention Type: BEHAVIORAL; Name: sharing information with community pharmacist; Assigned to Arm(s): Intervention | Intervention Type: BEHAVIORAL; Name: Medication use evaluations by community pharmacist; Assigned to Arm(s): Intervention | Intervention Type: BEHAVIORAL; Name: informing physician if patient has stopped a medication; Assigned to Arm(s): Intervention | Intervention Type: BEHAVIORAL; Name: Routine discharge counseling; Assigned to Arm(s): Intervention, Usual Care | Intervention Type: OTHER; Name: Letter to physician/discharge summary; Assigned to Arm(s): Intervention, Usual Care
B: Arm Label: STRIP intervention; Type: EXPERIMENTAL; Interventions: Other: STRIP intervention | Arm Label: Control; Type: SHAM_COMPARATOR; Interventions: Other: Control | Intervention Type: OTHER; Name: STRIP intervention; Assigned to Arm(s): STRIP intervention | Intervention Type: OTHER; Name: Control; Assigned to Arm(s): Control
C: Arm Label: Group 1; Type: NO_INTERVENTION; Interventions: N/A | Arm Label: Group 2; Type: EXPERIMENTAL; Interventions: Behavioral: COPD Self-management Education | Intervention Type: BEHAVIORAL; Name: COPD Self-management Education; Assigned to Arm(s): Group 2
D: Arm Label: Statin Choice Decision Aid; Type: ACTIVE_COMPARATOR; Interventions: Other: Statin Choice Decision Aid, Other: Usual care for antihyperglycemic medication | Arm Label: Diabetes Medication Choice Decision Aid; Type: ACTIVE_COMPARATOR; Interventions: Other: Diabetes Medication Choice Decision Aid, Other: Usual care for lipid therapy medication | Intervention Type: OTHER; Name: Diabetes Medication Choice Decision Aid; Assigned to Arm(s): Diabetes Medication Choice Decision Aid | Intervention Type: OTHER; Name: Statin Choice Decision Aid; Assigned to Arm(s): Statin Choice Decision Aid | Intervention Type: OTHER; Name: Usual care for lipid therapy medication; Assigned to Arm(s): Diabetes Medication Choice Decision Aid | Intervention Type: OTHER; Name: Usual care for antihyperglycemic medication; Assigned to Arm(s): Statin Choice Decision Aid

Answer: C