Does outpatient telephone coaching add to hospital quality improvement following hospitalization for acute coronary syndrome?

<bold>Background: </bold>Telephone counseling in chronic disease self-management is increasing, but has not been tested in studies that control for quality of medical care.<bold>Objective: </bold>To test the effectiveness of a six-session outpatient telephone-based counseling intervention to improve secondary prevention (behaviors, medication) in patients with acute coronary syndrome (ACS) following discharge from hospital, and impact on physical functioning and quality of life at 8 months post-discharge.<bold>Design: </bold>Patient-level randomized trial of hospital quality improvement (QI-only) versus quality improvement plus brief telephone coaching in three months post-hospitalization (QI-plus).<bold>Data: </bold>medical record, state vital records, patient surveys (baseline, three and eight months post-hospitalization).<bold>Analysis: </bold>pooled-time series generalized estimating equations to analyze repeated measures; intention-to-treat analysis.<bold>Participants: </bold>Seven hundred and nineteen patients admitted to one of five hospitals in two contiguous mid-Michigan communities enrolled; 525 completed baseline surveys.<bold>Measurements: </bold>We measured secondary prevention behaviors, physical functioning, and quality of life.<bold>Results: </bold>QI-plus patients showed higher self-reported physical activity (OR = 1.53; p = .01) during the first three months, with decline after active intervention was withdrawn. Smoking cessation and medication use were not different at 3 or 8 months; functional status and quality of life were not different at 8 months.<bold>Conclusions: </bold>Telephone coaching post-hospitalization for ACS was modestly effective in accomplishing short-term, but not long-term life-style behavior change. Previous positive results shown in primary care did not transfer to free-standing telephone counseling as an adjunct to care following hospitalization. [ABSTRACT FROM AUTHOR]