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

J Gen Intern Med. 2008 Sep;23(9):1464-70. doi: 10.1007/s11606-008-0710-1. Epub 2008 Jul 10.


Background: Telephone counseling in chronic disease self-management is increasing, but has not been tested in studies that control for quality of medical care.

Objective: 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.

Design: Patient-level randomized trial of hospital quality improvement (QI-only) versus quality improvement plus brief telephone coaching in three months post-hospitalization (QI-plus).

Data: medical record, state vital records, patient surveys (baseline, three and eight months post-hospitalization).

Analysis: pooled-time series generalized estimating equations to analyze repeated measures; intention-to-treat analysis.

Participants: Seven hundred and nineteen patients admitted to one of five hospitals in two contiguous mid-Michigan communities enrolled; 525 completed baseline surveys.

Measurements: We measured secondary prevention behaviors, physical functioning, and quality of life.

Results: 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physical activity (OR = 1.53; p = .01) during the first three months, with decline after active intervention was withdrawn.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.

Conclusions: 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.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Activities of Daily Living*
  • Acute Coronary Syndrome / therapy*
  • Aged
  • Directive Counseling*
  • Female
  • Health Behavior
  • Humans
  • Male
  • Middle Aged
  • Outpatients
  • Quality of Life
  • Telemedicine*