Comprehensive Home-based Self-management Support for COPD Patients
June 2019 - April 2022
National Heart, Lung, and Blood Institute (NHLBI) via Mt Sinai School of Medicine
We will adapt and expand an effective model of asthma self-management support for patients with chronic obstructive pulmonary disease (COPD). In this new model, community health workers will comprehensively screen for and address barriers to effective COPD self-management, including maladaptive coping behaviors, and guide patients through home-based pulmonary rehabilitation. Feasibility of the new model will be assessed in preparation for a fully powered, multisite randomized trial.
The debilitating nature of chronic obstructive pulmonary disease (COPD) can be mitigated through careful self-management behaviors, like consistent use of COPD medications and pulmonary rehabilitation. Unfortunately, COPD self-management support programs have produced disappointing results and access to pulmonary rehabilitation is limited, indicating that new approaches to supporting COPD patients are needed. We propose the Supporting self-Management Behaviors in Adults (SaMBA)—COPD model in response to this need. We previously developed and demonstrated the effectiveness of the Supporting Asthma Self-Management Behaviors for aging Adults (SAMBA) model, a unique chronic illness self- management support strategy that involves comprehensively screening for barriers to effective self- management and disease control coupled with tailored, theory-based, barrier-specific interventions. To improve COPD outcomes, we will refine and adapt the SAMBA model for COPD. In the process, we will introduce new theoretical considerations to the model, specifically addressing coping behaviors, and introduce home-based pulmonary rehabilitation lead by community health workers. The Specific Aims are to (1) establish the SaMBA-COPD model with extensive stakeholder input, and (2) and conduct a small, randomized controlled trial to determine feasibility of the model and determine effect sizes in preparation for a fully powered trial. We will convene a group of patients, clinicians, community health workers, and representatives of a health system and a major health insurer to adapt the SAMBA model for COPD care. Innovative features will include comprehensive screening to identify barriers to effective COPD self- management, a focus on coping behaviors that will advance self-management behaviors as posited by the Common Sense Model of Self-Regulation, and a home-based pulmonary rehabilitation feature lead by community health workers. By the end of Year 1, the SaMBA-COPD model and materials will be ready for feasibility testing (n=58). This project is significant for aiming to improve SMB in patients with COPD, a common and crippling illness, filling major gaps left by other COPD self-management support programs, and assessing the generalizability of a new model of self-management support by testing it in a new condition. The intervention itself is innovative for its comprehensive, patient-centered, stakeholder- designed approach to identifying and addressing barriers to effective SMB in COPD, including coping behaviors, for engaging CHWs in its delivery, and for integrating home-based pulmonary rehabilitation in a potentially low cost and sustainable delivery model.
• Principal Investigators: Juan Wisnivesky, MD; Alex Federman, MD; Michael S. Wolf, PhD MPH
• Project Lead: Sarah Wozniak