Abstract Introduction Hospital readmissions for chronic obstructive pulmonary disease (COPD) remain a major clinical and financial burden. Evidence-based transition-of-care (TOC) interventions can reduce revisits, though implementation and long-term sustainment remain challenging. The “Reduce REVISITS” study evaluated effectiveness and durability of a COPD TOC bundle randomized to deliver interventions either virtually or in-person; all sites received mentored support; half randomized to also received co-design support. Methods In this hybrid type II effectiveness-implementation cluster randomized trial sites were assigned to one of four groups: (G1) virtual + co-design, (G2) in-person + co-design, (G3) virtual, and (G4) in-person. Co-primary effectiveness and implementation outcomes were 30-day COPD-specific revisits (ED and/or rehospitalizations) and bundle reach. Secondary outcomes included additional utilization and intervention reach outcomes. Analyses used generalized estimating equation (GEE) models with a logit link, comparing baseline, implementation, and post-implementation periods. Results The post-implementation cohort included twenty sites with 10,732 unique patients (Group 1: 2,912; Group 2: 2,244; Group 3: 1,830; Group 4: 1,661). Of note, one site in Group 3 had missing data and one site in Group 4 contributed only partial data for this post-implementation analysis. Demographic and site characteristics differed significantly across groups (all p 0.001; gender p = 0.005). Overall, 30-day COPD-specific revisits declined from 17.1% at baseline to 13.1% during implementation (p 0.001) and remained low at 11.9% post-implementation (GEE = 17.0, 13.0, 12.2 percent; p = 0.02). Similarly, 90-day COPD revisits decreased from 23.8% to 21.0% to 19.6% (p = 0.02). All-cause 30-day revisits were 22.9%, 22.9%, and 25.8% (p 0.9 for baseline-to-implementation). Post-implementation, 30-day COPD revisits were 12.0% (G1), 12.6% (G2), 17.4% (G3), and 16.6% (G4). Site randomized to virtual (vs. in-person) intervention delivery achieved lower estimated 30-day COPD revisits (12.1% vs. 14.5%; p = 0.03). Groups randomized to receive co-design (vs. mentor only) support achieved greater bundle reach (67% vs. 54%; p = 0.01). Demographic characteristics and outcome data are summarized in Table 1. Conclusion Implementation of mentored COPD TOC bundles produced significant and sustained reductions in COPD-specific revisits across implementation (1 year) and the first year of a two-year post-implementation period. Sites randomized to virtual intervention delivery paired with co-design support achieved the strongest and most durable improvements in revisits and bundle reach, highlighting this as the most effective and sustainable strategy for improving COPD TOC. Longer sustainment can be evaluated upon completion of the second post-implementation year. This abstract is funded by: NIH
Press et al. (2026) studied this question.