Skip to main content

Advertisement

SpringerLink
Log in

Does Outpatient Telephone Coaching Add to Hospital Quality Improvement Following Hospitalization for Acute Coronary Syndrome?

  • Original Article
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

Abstract

Background

Telephone counseling in chronic disease self-management is increasing, but has not been tested in studies that control for quality of medical care.

Objective

To test the effectiveness of a six-session outpatient telephone-based counseling intervention to improve secondary prevention (behaviors, medication) in patients with acute coronary syndrome (ACS) following discharge from hospital, and impact on physical functioning and quality of life at 8 months post-discharge.

Design

Patient-level randomized trial of hospital quality improvement (QI-only) versus quality improvement plus brief telephone coaching in three months post-hospitalization (QI-plus). Data: medical record, state vital records, patient surveys (baseline, three and eight months post-hospitalization). Analysis: pooled-time series generalized estimating equations to analyze repeated measures; intention-to-treat analysis.

Participants

Seven hundred and nineteen patients admitted to one of five hospitals in two contiguous mid-Michigan communities enrolled; 525 completed baseline surveys.

Measurements

We measured secondary prevention behaviors, physical functioning, and quality of life.

Results

QI-plus patients showed higher self-reported physical activity (OR = 1.53; p = .01) during the first three months, with decline after active intervention was withdrawn. Smoking cessation and medication use were not different at 3 or 8 months; functional status and quality of life were not different at 8 months.

Conclusions

Telephone coaching post-hospitalization for ACS was modestly effective in accomplishing short-term, but not long-term life-style behavior change. Previous positive results shown in primary care did not transfer to free-standing telephone counseling as an adjunct to care following hospitalization.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1

Similar content being viewed by others

References

  1. Smith SC Jr., Allen J, Blair SN, et al. AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update: endorsed by the National Heart, Lung, and Blood Institute. Circulation. 2006;113:2363–72.

    Article  PubMed  Google Scholar 

  2. Peterson ED, Roe MT, Mulgund J, et al. Association between hospital process performance and outcomes among patients with acute coronary syndromes. JAMA. 2006;295:1912–20.

    Article  PubMed  CAS  Google Scholar 

  3. Mehta RH, Montoye CK, Gallogly MJ, et al. Improving quality of care for acute myocardial infarction: The Guidelines Applied in Practice (GAP) Initiative. JAMA. 2002;287:1269–76.

    Article  PubMed  Google Scholar 

  4. Koertge J, Weidner G, Elliott-Eller M, et al. Improvement in medical risk factors and quality of life in women and men with coronary artery disease in the Multicenter Lifestyle Demonstration Project. Am J Cardiol. 2003;91:1316–22.

    Article  PubMed  Google Scholar 

  5. Steptoe A, Kerry S, Rink E, Hilton S. The impact of behavioral counseling on stage of change in fat intake, physical activity, and cigarette smoking in adults at increased risk of coronary heart disease. Am J Public Health. 2001;91:265–9.

    Article  PubMed  CAS  Google Scholar 

  6. Stead LF, Perera R, Lancaster T. Telephone counselling for smoking cessation. Cochrane Database of Systematic Reviews. 2006 Issue 3.Art. No. CD002850 doi:10.1002/14651858. CD002850.pub2.

  7. Vale MJ, Jelinek MV, Best JD, et al. Coaching patients On Achieving Cardiovascular Health (COACH): a multicenter randomized trial in patients with coronary heart disease. Arch Intern Med. 2003;163:2775–83.

    Article  PubMed  Google Scholar 

  8. Wadland WC, Soffelmayr B, Ives K. Enhancing smoking cessation of low-income smokers in managed care. J Fam Pract. 2001;50:138–44.

    PubMed  CAS  Google Scholar 

  9. Mehta RH, Montoye CK, Faul J, et al. Enhancing quality of care for acute myocardial infarction: shifting the focus of improvement from key indicators to process of care and tool use: the American College of Cardiology Acute Myocardial Infarction Guidelines Applied in Practice Project in Michigan: Flint and Saginaw Expansion. J Am Coll Cardiol. 2004;43:2166–73.

    Article  PubMed  Google Scholar 

  10. Watson RE, Stein AD, Dwamena FC, et al. Do race and gender influence the use of invasive procedures? J Gen Intern Med. 2001;16:227–34.

    Article  PubMed  CAS  Google Scholar 

  11. Barber K, Stommel M, Kroll J, Holmes-Rovner M, McIntosh B. Cardiac rehabilitation for community-based patients with myocardial infarction: factors predicting discharge recommendation and participation. J Clin Epidemiol. 2001;54:1025–30.

    Article  PubMed  CAS  Google Scholar 

  12. Dwamena FC, El Tamimi H, Watson RE, et al. The use of angiotensin-converting enzyme inhibitors in patients with acute myocardial infarction in community hospitals. Michigan State University Inter-Institutional Collaborative Heart (MICH) Study Group. Clin Cardiol. 2000;23:341–6.

    Article  PubMed  CAS  Google Scholar 

  13. Census Bureau. County Population Datasets. State of Michigan. 2006. Lansing Michigan.

  14. Krumholz HM, Currie PM, Riegel B, Phillips, CO, Peterson ED, Smith R, et al. A taxonomy for disease management: a scientific statement from the American Heart Association Disease Management Taxonomy Writing Group. Circulation. 2006;114:1432–45.

    Article  PubMed  Google Scholar 

  15. Irvin JE, Bowers CA, Dunn ME, Wang MC. Efficacy of relapse prevention: a meta-analytic review. J Consult Clin Psychol. 1999;67:563–70.

    Article  PubMed  CAS  Google Scholar 

  16. Burke BL, Arkowitz H, Menchola M. The efficacy of motivational interviewing: a meta-analysis of controlled clinical trials. J Consult Clin Psychol. 2003;71:843–61.

    Article  PubMed  Google Scholar 

  17. Prochaska JO, DiClemente CC, Norcross JC. In search of how people change. Applications to addictive behaviors. Am Psychol. 1992;47:1102–14.

    Article  PubMed  CAS  Google Scholar 

  18. Britt E, Hudson SM, Blampied NM. Motivational interviewing in health settings: a review. Patient Educ Couns. 2004;53:147–55.

    Article  PubMed  Google Scholar 

  19. Holtrop JS, Corser W, Jones G, Brooks G, Holmes-Rovner M, Stommel M. Health behavior goals of cardiac patients after hospitalization. Am J Health Behav. 2006;30:387–99.

    PubMed  Google Scholar 

  20. Boyle RG, O’Connor PJ, Pronk NP, Tan A. Stages of change for physical activity, diet, and smoking among HMO members with chronic conditions. Am J Health Promot. 1998;12:170–5.

    PubMed  CAS  Google Scholar 

  21. Cardinal BJ. Behavioral and biometric comparisons of the preparation, action, and maintenance stages of exercise. Wellness Perspect. 1995;11:37–43.

    Google Scholar 

  22. Hlatky MA, Boineau RE, Higginbotham MB, Lee KL, Mark DB, Califf RM, et al. A brief self-administered questionnaire to determine functional capacity (the Duke Activity Status Index). Am J Cardiol. 1989;64:651–4.

    Article  PubMed  CAS  Google Scholar 

  23. Kind P, Dolan P, Gudex C, Williams A. Variations in population health status: results from a United Kingdom national questionnaire survey. BMJ. 1998;316:736–41.

    PubMed  CAS  Google Scholar 

  24. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–83.

    Article  PubMed  CAS  Google Scholar 

  25. Radloff L. The CES-D Scale: a self-report depression scale for research in the General Population. Appl Psychol Measuremt. 1997;1:385–401.

    Article  Google Scholar 

  26. Diggle P, Heagarty P, Lian K-Y, Zeger S. Analysis of Longitudinal Data, 2nd edn. New York: Oxford University Press; 2002.

    Google Scholar 

  27. Everitt PS, Pickles MP. Statistical Aspects of the Design and Analysis of Clinical Trials. London: Imperial College Press; 2004.

    Google Scholar 

  28. Cohen J. Statistical Power Analysis for the Behavioral Sciences. Hillsdale: Erlbaum; 1988.

    Google Scholar 

  29. Eagle KA, Montoye CK, Riba AL, DeFranco AC, Parrish R, Skorcz, S, et al. Guideline-based standardized care is associated with substantially lower mortality in medicare patients with acute myocardial infarction: the American College of Cardiology’s Guidelines Applied in Practice (GAP) Projects in Michigan. J Am Coll Cardiol. 2005;46:1242–8.

    Article  PubMed  Google Scholar 

  30. Wadland WC, Holtrop JS, Weismantel D, Pathak PK, Fadel H, Powell J. Practice-based referrals to a tobacco cessation quit line: assessing the impact of comparative feedback vs general reminders. Ann Fam Med. 2007;5:135–42.

    Article  PubMed  Google Scholar 

  31. Holtrop JS, Wadland WC, Vansen S, Weismantel D, Fadel H. Recruiting health plan members receiving pharmacotherapy into smoking cessation counseling. Am J Manag Care. 2005;11:501–7.

    PubMed  Google Scholar 

  32. Woolf SH, Glasgow RE, Krist A, Bartz, C, Flocke SA, Holtrop, JS, et al. Putting it together: finding success in behavior change through integration of services. Ann Fam Med. 2005;3(Suppl 2):S20–7.

    Article  PubMed  Google Scholar 

  33. Mistiaen P, Poot E. Telephone follow-up, initiated by a hospital-based health professional, for postdischarge problems in patients discharged from hospital to home. Cochrane Database of Systematic Reviews 2006, Issue 4. Art. No.:CD004510. doi:10.1002/14651858.CD004510.pub3.

  34. O’Connor AM, Bennett C, Stacey D, Barry, MJ, Col, NF, Eden, KB, et al. Do patient decision aids meet effectiveness criteria of the international patient decision aid standards collaboration? A systematic review and meta-analysis. Med Decis Mak. 2007;27:554–74.

    Article  Google Scholar 

  35. Johnson A, Sandford J, Tyndall J. Written and verbal information versus verbal information only for patients being discharged from acute hospital settings to home. Cochrane Database of Systematic Reviews 2003, Issue 4. Art. No.: CD003716. doi:10.1002/14651858.CD003716.

  36. Lewin SA, Skea ZC, Entwistle V, Zwarenstein M, Dick J. Interventions for providers to promote a patient-centred approach in clinical consultations. Cochrane Database of Systematic Reviews. 2001, Issue 4. Art. No.CD003267 doi:10.1002/14651858.CD003267.

  37. Wetzels R, Harmsen M, van Weel C, Grol R, Wensing M. Interventions for improving older patients’ involvement in primary care episodes. Cochrane Database of Systematic Reviews 2007, Issue 1. Art. No.: CD004273. doi:10.1002/14651858.CD004273.pub2.

  38. Lorig KR, Ritter PL, Laurent DD, Fries JF. Long-term randomized controlled trials of tailored-print and small-group arthritis self-management interventions. Med Care. 2004;42:346–54.

    Article  PubMed  Google Scholar 

  39. Foster G, Taylor SJC, Eldridge S, Ramsay J, Griffiths CJ. Self-management education programmes by lay leaders for people with chronic conditions. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD005108. doi:10.1002/14651858.CD005108.pub2.

  40. O’Connor AM, Stacey D, Entwistle V, Llewellyn-Thomas H, Rovner D, Holmes-Rovner M, Tait V, Tetroe J, Fiset V, Brry M, Jones J. Decision aids for people facing health treatment or screening decisions. Cochrane Database of Systematic Reviews 2003, Issue 1. Art. No.: CD001431. doi:10.1002/14651858. CD001431.

  41. O’Connor AM, Rostom A, Fiset V, Tetroe J, Entwistle V, Llyewellyn-Thomas, H, et al. Decision aids for patients facing health treatment or screening decisions: systematic review. BMJ. 1999;319:731–4.

    PubMed  CAS  Google Scholar 

Download references

Acknowledgments

Special thanks to Chrystal Price, MS, for data entry, Camille Proden, RN, BSN, community project manager, for supervision of field staff, study recruitment and medical record auditing, and to Cynthia Alderson (deceased) for project management. The sponsor had no role in the design and conduct of the study; collection, management, analysis, or interpretation of the data; preparation review or approval of the manuscript. Presented in part at: the Society for General Internal Medicine Annual Meeting, 2006.

Funding/Support

Supported in part by an AHRQ R01 grant (HS10531), “Translating Research: Patient Decision Support/Coaching” (Dr. Margaret Holmes-Rovner, Principal Investigator). None of the authors receives compensation from any of the hospitals studied. No consultancies, honoraria, stock ownership, expert testimony, grants received, grants pending, patients pending, patients received or royalties or other relationships represent a conflict of interest for any of the authors.

Author information

Authors and Affiliations

  1. Center for Ethics, C203 E. Fee Hall, Michigan State University College of Human Medicine, East Lansing, MI, USA

    Margaret Holmes-Rovner PhD

  2. Department of Medicine, College of Human Medicine, East Lansing, MI, USA

    Margaret Holmes-Rovner PhD & Adesuwa Olomu MD, MS

  3. College of Nursing, Michigan State University, East Lansing, MI, USA

    Manfred Stommel PhD, William D. Corser PhD, RN & Azfar Siddiqi MD, PhD

  4. Department of Family Medicine, College of Human Medicine, East Lansing, MI, USA

    Jodi Summers Holtrop PhD

  5. Department of Nursing, Hope College, Holland, MI, USA

    Susan L. Dunn PhD, RN

Authors
  1. Margaret Holmes-Rovner PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Manfred Stommel PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. William D. Corser PhD, RN
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Adesuwa Olomu MD, MS
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jodi Summers Holtrop PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Azfar Siddiqi MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Susan L. Dunn PhD, RN
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Margaret Holmes-Rovner PhD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Holmes-Rovner, M., Stommel, M., Corser, W.D. et al. Does Outpatient Telephone Coaching Add to Hospital Quality Improvement Following Hospitalization for Acute Coronary Syndrome?. J GEN INTERN MED 23, 1464–1470 (2008). https://doi.org/10.1007/s11606-008-0710-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11606-008-0710-1

KEY WORDS

Search

Navigation