Nurse and social worker telecare team intervention improved quality of life in high-risk patients with COPD, heart failure, or interstitial lung disease.
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Key Takeaway
Consider the ADAPT telecare team intervention for high-risk patients with COPD, heart failure, or interstitial lung disease.
This randomized clinical trial examined the content, processes, and cost of delivering the ADAPT intervention among 153 high-risk patients with chronic obstructive pulmonary disease, heart failure, or interstitial lung disease. The setting was multisite. The primary outcomes included quality of life, disease-specific health status, depression, and anxiety. Secondary outcomes included intervention session frequency and duration, team recommendations, and per-patient cost.
The mean length of intervention was 115.1 days with a standard deviation of 33.4 days. Participants averaged 10.0 sessions with a nurse (SD 3.3) and 9.5 sessions with a social worker (SD 3.4). Completion of required social work sessions occurred in 80.4% of cases. All required nurse sessions were completed. Team discussions averaged 3.7 times per participant (SD 1.8). Participants received an average of 7 recommendations per participant (SD 3.8). Referrals or consults occurred in 79.7% of cases. Medication additions occurred in 58.1% of cases, medication changes in 31.8%, and tests in 33.1%.
The mean cost per patient was $1139.68 with a standard deviation of $368.15. Safety data regarding adverse events, serious adverse events, discontinuations, and tolerability were not reported. The study limitations were not reported. Funding or conflicts of interest were not reported. The practice relevance indicates that the intervention produced clinically meaningful changes in multiple quality of life outcomes for a relatively low cost.
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View Original Abstract ↓
CONTEXT: In a multisite randomized clinical trial, a nurse and social worker telecare team intervention (ADAPT) improved quality of life, disease-specific health status, depression, and anxiety among high-risk patients with chronic obstructive pulmonary disease, heart failure, or interstitial lung disease.
OBJECTIVES: Examine the content, processes, and cost of delivering the ADAPT intervention.
METHODS: Analysis of prospectively collected data from the ADAPT randomized clinical trial, including intervention session frequency/duration, team recommendations, and per-patient cost to deliver the intervention using time-driven activity-based costing.
RESULTS: Mean length of the intervention was 115.1 (SD 33.4) days. Participants (n = 153) averaged 10.0 (SD 3.3) sessions with the nurse and 9.5 (SD 3.4) sessions with the social worker; 80.4% completed all required social work sessions and all required nurse sessions. The team discussed each participant an average of 3.7 (SD 1.8) times and made 7 (SD 3.8) recommendations per participant. Common recommendations included referrals/consults (79.7%, e.g., mental health, sleep, PT/OT, other specialists), medication additions (58.1%) or changes (31.8%), and tests (33.1%). The mean cost to implement and deliver the intervention per patient was $1139.68 (SD $368.15).
CONCLUSION: In a successful nurse and social work telecare team intervention, there was high participation in nurse and social worker sessions, individualized medical and behavioral interventions, and connecting of participants to existing medical and community resources. The intervention produced clinically meaningful changes in multiple quality of life outcomes for a relatively low cost.
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