Take My Breath AwayF. Amos Bailey, MD Dec 28, 2018
Aboumatar and colleagues at Johns Hopkins recently published a study in JAMA about their intervention to help people living with COPD manage this chronic illness after being hospitalized with an exacerbation. The 240 people with COPD were randomized to usual care versus the study arm which was led by nurses who met with the patient and family during the hospital stay and contacted them at home or on the phone for the next three months.
In their own words the intervention provided…
Transition support to try to ensure that patients and caregivers were prepared for discharge and understood the post discharge plan of care.
Individualized COPD self-management support to help patients take medications correctly, recognize exacerbations signs and follow action plan, practice breathing exercises and energy conservation techniques, maintain an active lifestyle, seek help as needed, and stop smokingFacilitated access to community programs and treatment services.The intervention was delivered by COPD nurses (ie, nurses with special training on supporting patients with COPD using standardized tools). The nurses met with the patient (and caregiver whenever possible) during the hospital stay and for 3 months after discharge. They provided self-management support and addressed barriers to care. The program followed a patient-centered partnership approach, and was delivered during a series of sessions held at the hospital and after discharge via home visit or telephone.15
Although this is not labeled a palliative care intervention, as you can see, the emphasis was on patient-centered care with patient and family education, symptom self-managed, and links to community programs. The only thing missing is Advance Care Planning!
Why is the published in JAMA? This “simple” intervention reduced ED visits and re-hospitalization by 50% over the next 6 months and improved self-reported quality of life. The intervention was tested against “usual” care but ought everything in the intervention be usual care? In our healthcare system, high touch care as described in this study is just not as “sexy” as high tech care.
Palliative care providers will find allies and colleagues working in projects like this one and others which emphasize high touch care.
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To hear Jessica Simpson sing You Take My Breath Away