A23-03 Integrating Human-Centered Design and Mentored Implementation to Improve COPD Outcomes: The Reduce Revisits Study

Abstract Rationale Chronic obstructive pulmonary disease (COPD) affects over 16 million U.S. adults, with approximately 700,000 hospitalized annually and nearly 20% readmitted within 30 days. Preventable revisits impose substantial burdens on patients and health systems, leading Medicare to include COPD in its Hospital Readmission Reduction Program (HRRP). Evidence-based, non-pharmacologic interventions—including early pulmonary rehabilitation, inhaler education, and prompt post-discharge follow-up—can reduce readmissions, yet hospitals often have difficulty with consistent, if any, implementation. Mentored implementation (MIM) is an evidence-based approach that supports best practices adoption. However, additional implementation support may increase outcomes such as effectiveness, reach, and sustainment compared to MIM alone. One additional implementation support that can be integrated with MIM is the use of co-design, a human-centered design (HCD) method. Evidence directly linking HCD methods of implementation support to improved health or implementation outcomes remains limited. Methods The Reduce REVISITS study evaluated MIM with or without structured co-design support to implement evidence-based COPD transition-of-care intervention bundles. Designers experienced in health services developed a co-design process guiding site teams in planning and adapting interventions. 21 U.S. hospitals were randomized to deliver bundles either in-person or virtually, with or without structured co-design support. Mentored teams implemented non-pharmacologic interventions known to reduce COPD readmissions. Sites engaged multidisciplinary teams and, if randomized to co-design, incorporated patient and caregiver feedback on planned care experiences and associated educational materials for one intervention (inhaler education or post-discharge follow-up visits). Results Of 21 hospitals randomized, 20 completed the implementation period. Of these 20 sites, 11 were randomized to co-design (virtual: 6, in-person; 5), and 7 and 4 focused on inhaler teaching or post-discharge, respectively. Hospitals receiving co-design support achieved lower 30-day COPD-specific revisit rates compared with sites using MIM alone (co-design: 12.8% vs. no co-design: 14.3%, p = 0.005). Virtual sites supported by co-design demonstrated the most significant improvements (virtual + co-design: 11.5% vs. other three groups: 15.0%, p 0.001). Qualitative findings (Table) indicated that co-design enhanced cross-disciplinary collaboration, local ownership, and elevated patient and caregiver perspectives, which informed practical adjustments improving relevance and usability. Conclusion Integrating HCD methods with MIM is a promising strategy to improve COPD care delivery and outcomes. Structured co-design, led by designers experienced in health services, enabled hospital teams to center patient and caregiver experiences in implementation, contributing to reduced revisits. Future work should identify specific co-design elements driving improved outcomes and develop scalable models linking HCD with implementation effectiveness and care quality. This abstract is funded by: NIH