COPD Clinical Trial
— BREATHOfficial title:
CSP #560 - Bronchitis and Emphysema Advice and Training to Reduce Hospitalization (BREATH)
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.
Status | Terminated |
Enrollment | 426 |
Est. completion date | September 2010 |
Est. primary completion date | September 2010 |
Accepts healthy volunteers | No |
Gender | Both |
Age group | 40 Years and older |
Eligibility |
Inclusion Criteria: Population to be studied The study population consists of VA patients with COPD who receive some of their medical care at Veterans Affairs medical centers and were hospitalized for COPD in the last 12 months. To ensure that patients enrolled in the study receive regular care at the participating VA, we will include only patients enrolled in either the primary care or pulmonary clinic at the VA medical center and were seen at least once in the last year. This criterion should not significantly decrease the number of eligible patients because 90% of patients admitted for COPD in the VA had at least 1 outpatient visit to the VA primary care clinic in the year prior to their hospitalization based on data from the VA OPC in FY03. Inclusion Criteria: 1. Diagnosis of COPD confirmed by all of the following: 1. FEV1/FVC < 0.70 2. FEV1 < 80% 3. Age > 40 years 4. A current or past history of cigarette smoking (> 10 pack-years) 2. COPD hospitalization in the previous year 3. Receives care at participating VA medical center 1. Enrolled in either primary care or pulmonary clinic at the VA 2. Seen at least once in the past year in either primary care or pulmonary clinic 4. No COPD exacerbations in last 4 weeks 5. English-speaking 6. Access to telephone Exclusion Criteria: 1. Primary clinical diagnosis of asthma 2. Medical conditions affecting the ability to participate in the study such as: 1. Comorbid illness likely to limit life expectancy < 1 year 2. Decompensated heart failure 3. Dementia 4. Uncontrolled psychiatric illness 3. Participation in another clinical intervention trial in the previous 30 days |
Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Prevention
Country | Name | City | State |
---|---|---|---|
United States | New Mexico VA Health Care System, Albuquerque | Albuquerque | New Mexico |
United States | VA Medical Center, Bay Pines | Bay Pines | Florida |
United States | VA Western New York Healthcare System at Buffalo | Buffalo | New York |
United States | VA Medical Center, Cincinnati | Cincinnati | Ohio |
United States | VA North Texas Health Care System, Dallas | Dallas | Texas |
United States | Atlanta VA Medical and Rehab Center, Decatur | Decatur | Georgia |
United States | North Florida/South Georgia Veterans Health System | Gainesville | Florida |
United States | Michael E. DeBakey VA Medical Center (152) | Houston | Texas |
United States | Richard Roudebush VA Medical Center, Indianapolis | Indianapolis | Indiana |
United States | VA Medical Center, Kansas City MO | Kansas City | Missouri |
United States | VA Medical Center, Lexington | Lexington | Kentucky |
United States | VA Medical Center, Loma Linda | Loma Linda | California |
United States | New York Harbor HCS | New York | New York |
United States | VA Medical Center, Oklahoma City | Oklahoma City | Oklahoma |
United States | VA Palo Alto Health Care System | Palo Alto | California |
United States | Carl T. Hayden VA Medical Center | Phoenix | Arizona |
United States | VA Medical Center, Providence | Providence | Rhode Island |
United States | Hunter Holmes McGuire VA Medical Center | Richmond | Virginia |
United States | VA South Texas Health Care System, San Antonio | San Antonio | Texas |
United States | VA Puget Sound Health Care System | Seattle | Washington |
United States | Southern Arizona VA Health Care System, Tucson | Tucson | Arizona |
United States | Robert J. Dole VAMC & ROC, Wichita | Wichita | Kansas |
Lead Sponsor | Collaborator |
---|---|
VA Office of Research and Development |
United States,
Fan VS, Gaziano JM, Lew R, Bourbeau J, Adams SG, Leatherman S, Thwin SS, Huang GD, Robbins R, Sriram PS, Sharafkhaneh A, Mador MJ, Sarosi G, Panos RJ, Rastogi P, Wagner TH, Mazzuca SA, Shannon C, Colling C, Liang MH, Stoller JK, Fiore L, Niewoehner DE. A — View Citation
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Hospitalization-free Survival - Time to Event | From randomization until date of first hospitalization for COPD, assessed up to 26 months | No | |
Primary | Hazard Ratio for First COPD Hospitalization | 26 months | No | |
Secondary | Hazard Ratio for All-Cause Mortality | 26 months | Yes | |
Secondary | Time to All-Cause Death | From randomization until death, assessed up to 26 months | Yes |
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