Intensive out-of-hospital coaching for frequently hospitalized COPD patients: a before-after feasibility study

Bart A C Noort; Taco van der Vaart; Jan van der Maten; Esther Metting; Kees Ahaus

doi:10.3389/fmed.2023.1195481

Intensive out-of-hospital coaching for frequently hospitalized COPD patients: a before-after feasibility study

Front Med (Lausanne). 2023 Oct 17:10:1195481. doi: 10.3389/fmed.2023.1195481. eCollection 2023.

Authors

Bart A C Noort¹, Taco van der Vaart¹, Jan van der Maten², Esther Metting^{1

3

4}, Kees Ahaus⁵

Affiliations

¹ Department of Operations, Faculty of Economics and Business, University of Groningen, Groningen, Netherlands.
² Department of Pulmonology, Medical Center Leeuwarden, Leeuwarden, Netherlands.
³ Data Science Center in Health, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.
⁴ Department of Primary and Elderly Care, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.
⁵ Health Services Management and Organisation, School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands.

Abstract

Background: This study assesses whether out-of-hospital coaching of re-hospitalized, severe COPD patients by specialized respiratory nurses is feasible in terms of cost-effectiveness, implementation, and recipient acceptability. The coaching was aimed at improving patients' health management abilities, motivation for healthy behavior, strengthening the professional and informal care network, stimulating physiotherapy treatment and exercise training, improving knowledge on symptom recognition and medication use, and providing safety and support.

Methods: Cost-effectiveness of 6 months of out-of-hospital coaching was assessed based on a before-after intervention design, with real-life data and one-year follow-up. A total of 170 patients were included. Primary (questionnaires, meeting reports) and secondary data (insurance reimbursement data) were collected in one province in the Netherlands. The implementing and recipient acceptability was assessed based on the number of successfully delivered coaching sessions, questionnaire response rate, Patient Reported Experience Measure, and interviews with coaches.

Results: Post-intervention, the COPD-related hospitalization rate was reduced by 24%, and patients improved in terms of health status, anxiety, and nutritional status. Patients with a high mental burden and a poor score for health impairment and wellbeing at the start of the intervention showed the greatest reduction in hospitalizations. The coaching service was successfully implemented and considered acceptable by recipients, based on patient and coach satisfaction and clinical use of patient-reported measures.

Conclusion: The study demonstrates the value of coaching patients out-of-hospital, with a strong link to primary care, but with support of hospital expertise, thereby adding to previous studies on disease- or self-management support in either primary or secondary care settings. Patients benefit from personal attention, practical advice, exercise training, and motivational meetings, thereby improving health status and reducing the likelihood of re-hospitalization and its associated costs.

Keywords: COPD; feasibility; out-of-hospital coaching; re-hospitalization; real-life data; self-management.

Grants and funding

This study was funded by the Netherlands Organization for Scientific Research (NWO).