Optimizing Effectiveness and Implementation of COPD Self-Management Treatment - PROJECT SUMMARY/ ABSTRACT Chronic Obstructive Pulmonary Disease (COPD) is an increasingly prevalent and costly health condition, and is the third major cause of morbidity and mortality in the U.S. Although COPD self-management programs are effective in reducing respiratory-related hospitalizations and increasing quality of life, there is a limited understanding of ‘how and why’ they work, due to heterogeneity of treatment components. COPD self- management programs are also not widely implemented, due to treatment complexity and cost. In order to address these critical barriers to progress in the field, we will conduct a Hybrid Type 1 effectiveness- implementation study guided by the Multiphase Optimization Strategy (MOST). The proposed study is part of a line of research with the long-term objective of using MOST to optimize the effectiveness and implementation of COPD self-management treatment. In our pilot feasibility study (i.e., Preparation Phase), we piloted a factorial experiment that mirrors the design, study population, and community partnership of the proposed study. The proposed project will build on this work by conducting a factorial optimization trial (i.e., Optimization Phase) among 448 individuals with physician-diagnosed, self-reported COPD who have experienced an exacerbation in the past year. Treatment components include self-management education, physical activity, and inhaler training. The primary outcome is 12-month respiratory-related hospitalization, with secondary outcome of health-related quality of life. In addition to effectiveness outcomes, the optimization trial will collect information on a key implementation outcome: the program cost of delivering each treatment component. We will select an optimized treatment program that produces the best expected outcomes on respiratory-related hospitalization and health-related quality of life, while maintaining efficiency in the program cost of treatment delivery. We will also conduct a mixed method process evaluation with healthcare providers (N=10) and administrators (N=10). Guided by the Consolidated Framework for Implementation Research (CFIR), we will assess barriers and facilitators impacting the program referral workflow, and select implementation strategies to increase referrals to a remotely-delivered COPD self-management program. Results will advance our understanding of the component effects of COPD self-management treatment, alone and in combination, and how an optimized COPD self-management treatment program can best balance effectiveness with efficiency, affordability, and scalability. Our study team has relevant expertise in areas of behavioral medicine, COPD self-management, pulmonary medicine, health economics, MOST design/ analysis, and implementation science. Our research partnership with the American Lung Association Lung Helpline will enhance the reach of the study to individuals with COPD nationwide, particularly those in rural and underserved areas. Public Health Impact: The overall goal of the proposed project is to optimize the effectiveness and implementation of COPD self-management treatment to reduce the public health burden of COPD.
