At Home Spirometry and Video Module Education for COPD Patients
At Home Spirometry and Video Module Education for COPD Patients
The central hypothesis is that patients hospitalized for COPD who subsequently complete the
 at-home BREATHES Program with V-TTG skill training and SpiroPD adherence support will retain
 increased medication knowledge, skill, self-efficacy, and adherence that otherwise decays
 substantially by 30 days post-discharge. To test this hypothesis, this study proposes the
 following specific aims:

 Aim 1: Determine the feasibility of, adherence to, and efficacy of at-home V-TTG for ongoing
 inhaler skill training.

 Hypothesis: Participants who complete both in-hospital and at-home V-TTG will have a
 significantly increased likelihood of demonstrating effective respiratory inhaler technique
 within 30 days after hospital discharge compared to in-hospital technique

 Aim 2. Determine the feasibility of, adherence to, and efficacy of at-home SpiroPD for COPD
 medication adherence support.

 Hypothesis: Participants' use of SpiroPD (PMD Healthcare) will significantly improve their
 COPD medication adherence.
Chronic obstructive pulmonary disease (COPD) results in nearly 750,000 hospitalizations
 annually and is the third leading cause of 30-day hospital readmissions in the United
 States.Improving the quality of care for hospitalized COPD patients has recently become a
 national priority through the Centers for Medicare and Medicaid Services' Hospital
 Readmissions Reduction Program. A key element of improving care quality is translating
 existing evidence into improved practice. Extensive evidence exists to support the efficacy
 of inhaled medications to control and reduce COPD symptoms and to improve patient outcomes.
 However, the real-world effectiveness of these medications is often limited due both to poor
 inhaler technique and to insufficient adherence to treatment plans. Most interventions for
 hospitalized patients with COPD focus on medication reconciliation, treatment optimization,
 and inhaler technique education prior to being discharged home. However, after discharge
 home, patients quickly lose inhaler technique skills, have difficulty adhering to complex
 regimens, and lack tools to aid adherence, such as lung function response to their treatment
 regimen. Interventions to reinforce skills and support adherence are needed across care
 transitions to reduce the risk of deleterious health outcomes.

 Simple and feasible at-home interventions to provide skills training and adherence support
 are needed. This novel idea is to pair at-home inhaler skill training with at-home spirometry
 measurements to comprehensively support both medication skill and adherence. The investigator
 proposes testing a novel at-home self-management support program called "BREATHES" (Bringing
 Respiratory Education for improved Adherence and Technique Home through E-interventions for
 Self-management) Program. BREATHES will include two main components: first, self-directed
 inhaler skill training sessions through the virtual Teach-To-Goal (V-TTG) intervention the
 investigator developed and tested during a K23 grant and, second, a handheld lung function
 device to provide physiologic feedback and capture medication adherence called SpiroPD. TTG
 is a patient-centered strategy that uses cycles of assessment and demonstration tailored to
 patients' self-management needs; the investigator's research shows in-person TTG is effective
 for teaching inhaler technique and reduces acute care utilization. Virtual-TTG delivers the
 key features of TTG using virtual patient-directed lessons through novel adaptive technology
 that provides tailored self-assessment and training. The investigator's studies demonstrate
 participants' willingness to use V-TTG at-home for post-discharge booster education and show
 that V-TTG is effective and may be non-inferior to in-person TTG in significantly reducing
 inhaler misuse among hospitalized patients. However, it remains unknown whether at-home V-TTG
 sessions will maintain self-management skills over the longer term and how direct physiologic
 lung monitoring support can impact medication adherence. The proposed studies will determine
 whether combining at-home skill training with objective measurements of lung function and
 adherence monitoring through the BREATHES Program improves self-management skills and
 medication adherence in the first 30 days after hospitalization for COPD.
Inclusion Criteria:

 1. Age 18 years and older

 2. Physician-diagnosed COPD (prior to or during hospitalization)

 3. Owns a wifi-enabled device (desktop, laptop, tablet, smart phone, etc.)

 4. Discharged with a rescue and/or controller MDI, metered dose inhaler.

 Exclusion Criteria:

 1. Currently in an intensive care unit

 2. Physician declines to provide consent

 3. Patient unable to provide consent (e.g., history of cognitive impairment, unable to
 understand English) or declines to provide consent