A Comprehensive Disease Management Program to Improve Quality of Life in Disparity Hispanic and African-American Patients Admitted With Exacerbation of Chronic Pulmonary Diseases
| Status: | Recruiting |
|---|---|
| Conditions: | Pulmonary |
| Therapuetic Areas: | Pulmonary / Respiratory Diseases |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 7/5/2018 |
| Start Date: | April 1, 2017 |
| End Date: | December 30, 2019 |
| Contact: | Negin Hajizadeh, MD, MPH |
| Email: | nhajizadeh@northwell.edu |
| Phone: | 516-600-1401 |
Chronic Obstructive Pulmonary Disease (COPD), also known as emphysema, is the leading cause
of hospitalization for older adults in the U.S., and a leading cause of death. Although there
is no cure for COPD, a program called pulmonary rehabilitation (PR), which combines exercise
and education, can help decrease re-hospitalizations and improve patients' quality of life.
Unfortunately, very few COPD Latino and African-American patients actually get PR. These
patients are unlikely to get referrals or to be able to attend PR due to lack of insurance,
lack of transportation, or lack of a PR center in their area. Telehealth is a way of using
computers to deliver healthcare long-distance, eliminating the need for a patient to travel
to receive care. By using telehealth for PR, the patient can exercise on a stationary bike in
his or her home, while being supervised by videoconference by a respiratory therapist (RT).
The RT can "see" the patient, and deliver education by videoconference, and the patient can
"see" the RT, so the patient does not need to leave home to get PR.
of hospitalization for older adults in the U.S., and a leading cause of death. Although there
is no cure for COPD, a program called pulmonary rehabilitation (PR), which combines exercise
and education, can help decrease re-hospitalizations and improve patients' quality of life.
Unfortunately, very few COPD Latino and African-American patients actually get PR. These
patients are unlikely to get referrals or to be able to attend PR due to lack of insurance,
lack of transportation, or lack of a PR center in their area. Telehealth is a way of using
computers to deliver healthcare long-distance, eliminating the need for a patient to travel
to receive care. By using telehealth for PR, the patient can exercise on a stationary bike in
his or her home, while being supervised by videoconference by a respiratory therapist (RT).
The RT can "see" the patient, and deliver education by videoconference, and the patient can
"see" the RT, so the patient does not need to leave home to get PR.
Telehealth-delivered PR has been shown to be as effective as standard PR (patients go to an
outpatient setting) at improving quality of life, and patients' exercise capacity. However,
this has not been studied in the Latino and African-American population and it is not known
how effective telehealth PR will be among this population.
For this study, the investigators hope to see if they can help COPD Latino and
African-American patients with access to this needed resource through telehealth PR. They
will compare standard PR and telehealth PR to determine if telehealth results in better
outcomes for patients with moderate to severe COPD who were recently discharged from the
hospital for COPD. The primary outcome the investigators will assess will be change in
re-hospitalization rates. The secondary outcomes will include: change in quality of life,
preparation to make decisions about clinical care, improved functional capacity, decreased
dyspnea, anxiety, and depression.
The study will involve randomly assigning participants to make sure that they are just as
likely to be in one group as the other to receive either: 1) referral for
telehealth-delivered PR, or 2) referral to standard (outpatient) PR. Both PR programs consist
of exercise and education twice a week for 8 weeks. The investigators will give the patients
surveys to complete before they start the program and at the end of the program, to see if PR
had any effect on the outcomes that are being measured. The investigators will enroll about
276 patients - with 138 patients in each group (telehealth PR or standard PR), so they can
compare outcomes to see if telehealth PR was more, less, or equally effective as standard PR.
outpatient setting) at improving quality of life, and patients' exercise capacity. However,
this has not been studied in the Latino and African-American population and it is not known
how effective telehealth PR will be among this population.
For this study, the investigators hope to see if they can help COPD Latino and
African-American patients with access to this needed resource through telehealth PR. They
will compare standard PR and telehealth PR to determine if telehealth results in better
outcomes for patients with moderate to severe COPD who were recently discharged from the
hospital for COPD. The primary outcome the investigators will assess will be change in
re-hospitalization rates. The secondary outcomes will include: change in quality of life,
preparation to make decisions about clinical care, improved functional capacity, decreased
dyspnea, anxiety, and depression.
The study will involve randomly assigning participants to make sure that they are just as
likely to be in one group as the other to receive either: 1) referral for
telehealth-delivered PR, or 2) referral to standard (outpatient) PR. Both PR programs consist
of exercise and education twice a week for 8 weeks. The investigators will give the patients
surveys to complete before they start the program and at the end of the program, to see if PR
had any effect on the outcomes that are being measured. The investigators will enroll about
276 patients - with 138 patients in each group (telehealth PR or standard PR), so they can
compare outcomes to see if telehealth PR was more, less, or equally effective as standard PR.
Inclusion Criteria:
- Adult patients with a diagnosis of COPD (defined by one pulmonary function tests (PFT)
and who have not done pulmonary rehabilitation within the past 1 year and
- Hispanic or African-American (as defined by the patient him/herself).
Exclusion Criteria:
- individuals who completed PR in the past year or
- those unable to exercise or follow directions as determined by their outpatient
pulmonologist/cardiologist or
- A diagnosis of dementia listed in the patient's electronic medical record
- Patients who weigh more than 300 pounds
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