Health System Approach to Improve Chronic Obstructive Pulmonary Disease Care after Hospital Discharge: Stepped-Wedge Clinical Trial.

Patients discharged from the hospital for chronic obstructive pulmonary disease (COPD) exacerbation have impaired quality of life and frequent readmission and death. Clinical trials to reduce readmission demonstrate inconsistent results, including some demonstrating potential harms. We tested whether a pragmatic proactive interdisciplinary and virtual review of patients discharged after hospitalization for COPD exacerbation would improve quality of life, using the Clinical COPD Questionnaire, and reduce all-cause 180-day readmission and/or mortality.

Preferences for death and dying among veterans with chronic obstructive pulmonary disease.

Rationale: Studies identify common factors important for a "good death." However, it is important for clinicians to individualize end-of-life care by eliciting patients' preferences. We sought to determine preferences for death and dying among veterans with chronic obstructive pulmonary disease (COPD) by performing a cross-sectional study.

Patient-clinician communication about end-of-life care topics: is anyone talking to patients with chronic obstructive pulmonary disease?

Background: Reports describe patient and health care system benefits when clinicians engage in end-of-life conversations with patients diagnosed with life-limiting illnesses, yet most clinicians focus on life-preserving treatments and avoid conversations about end-of-life care. We describe patient-clinician communication practices about end-of-life care in patients with chronic obstructive pulmonary disease (COPD) using self-report questionnaires to: (1) characterize the content of patient-clinician communication about end-of-life care from the patient perspective, including topics that were not addressed and ratings of the quality of the communication for topics discussed and (2) determine whether clinician characteristics was associated with the absence of specific communication items addressed.

Methods: Cross-sectional study of outpatients (n = 376) who completed the Quality of Communication (QOC) questionnaire (outcome measure).

The association of depression and preferences for life-sustaining treatments in veterans with chronic obstructive pulmonary disease.

Context: Depressive symptoms are common among patients with chronic obstructive pulmonary disease (COPD) and may modify patients' preferences for life-sustaining therapy. Examining the relationship between patient preferences for life-sustaining treatments and depressive symptoms is important for clinicians engaging in end-of-life care discussions.

Objectives: To assess whether a history of depression or active depressive symptoms is associated with preferences for life-sustaining therapies among veterans with COPD.

Patient-clinician communication: associations with important health outcomes among veterans with COPD.

Background: High quality patient-clinician communication is widely advocated, but little is known about which health outcomes are associated with communication for patients with COPD.

Methods: Using a cross-sectional study of 342 veterans enrolled in a randomized controlled trial, we evaluated the association of communication, measured with the quality of communication (QOC) instrument, with subject-reported quality of clinician care, breathing problem confidence, and general self-rated health. We measured these associations using general estimating equations and adjusted odds ratios (OR) of patient-reported outcomes associated with one-point changes in QOC scores.