Rehabilitation for Patients With COPD
Condition: Chronic Obstructive Pulmonary Disease
MeSH terms: Lung Diseases, Obstructive; Pulmonary Disease, Chronic Obstructive
Study type: Interventional

Summary: 
      This study will examine COPD Wellness, a 10-week low-intensity pulmonary rehabilitation
      program consisting of group and home exercise, education, and social support can improve
      symptoms and increase physical activity in participants with COPD who receive care within a
      'safety-net' healthcare system (e.g. County Hospital). Half of the participants will also
      receive an adherence strategy targeted at addressing unmet social needs, while the other half
      will undergo the intervention without the adherence strategy.
    

Detailed description: 
      Chronic obstructive pulmonary disease (COPD), one of the leading causes of death in the US,
      disproportionately affects low socioeconomic communities. While few interventions effectively
      modify the course of COPD and improve outcomes, pulmonary rehabilitation is the one notable
      exception. However, implementation of this resource-intensive program in real-life settings,
      and in particular, for underserved communities, has proven to be challenging. Safety-net
      centers that serve primarily under-insured populations lack financial resources to provide
      pulmonary rehabilitation.

      COPD Wellness, a 10-week low-intensity pulmonary rehabilitation program consisting of group
      and home exercise, education, and social support, was developed to address this gap. This
      intervention is targeted at patients with moderate to severe COPD (GOLD Class B-D) who
      receive care through a safety-net health system. To be impactful, risk factors for low
      adherence include both disease severity and socio-environmental factors, must be addressed.
      As merely having a pulmonary rehabilitation program will not automatically lead to improved
      outcomes.

      As part of this study, an adherence strategy targeted at addressing unmet social needs to
      improve health will also be implemented. A Health Advocates program that links social needs
      screening with a tiered referral and linkage process to appropriate resources will be tested
      to see if adherence to COPD Wellness (exercise intervention) improves by addressing competing
      non-medical stressors.
    

Intervention name(s): COPD Wellness; Health Advocate
Intervention type(s): Behavioral; Behavioral
Intervention description(s): This is low-intensity pulmonary rehabilitation that incorporates exercise, nutrition, patient education, and a support group class.; The Zuckerberg San Francisco General (ZSFG) Hospital Health Advocates program links social needs screening with a tiered referral and linkage process to appropriate resources
Allocation: Randomized
Intervention model: Sequential Assignment
Intervention model description: A step-wedge design will allow all participants to receive the intervention. Participants not immediately enrolled into the intervention will serve as controls. At the time of the intervention, these participants will move over to the treatment arm.
The first two groups will be used to refine the COPD Wellness intervention and identify social barriers specific to individuals living with COPD. Starting with group 3, we will alternate the addition of the Health Advocates (HA) program as an adherence strategy in order to determine the HA's effect on participation in COPD Wellness.
Masking: Double (Investigator, Outcomes Assessor)
Primary purpose: Health Services Research
Keywords: Health Disparities; Lung Diseases; Self-management; Chronic Disease; Socio-economic status