# post-REcovery LIbEration From Oxygen in Exacerbated COPD (RELIEF)

> **NIH VA I01** · VA PUGET SOUND HEALTHCARE SYSTEM · 2021 · —

## Abstract

Projects such as the American Board of Internal Medicine’s “Choosing Wisely” campaign emphasize the
importance of identifying and de-implementing ineffective, harmful and/or wasteful practices to improve the
quality and safety of delivered care. Among patients with chronic obstructive pulmonary disease (COPD),
oxygen has been shown to improve survival among a specific subset of patients with severe resting
hypoxemia. The provision of oxygen therapy has been extrapolated to other populations leading to the
prescription of oxygen to patients with COPD who do not have an evidence-based indication for its use. For
example, oxygen is frequently prescribed upon discharge from hospital after an exacerbation of COPD, then
continued indefinitely, resulting in patients who become habituated to having oxygen readily accessible.
Published in 2016, the Long-Term Oxygen Treatment Trial (LOTT) demonstrated that the use of supplemental
oxygen conferred no benefit to patients with COPD who have moderate resting or ambulatory hypoxemia. In
addition to being ineffective in this patient population, supplemental oxygen can pose risks of harm, such as
the potential for fire or injury due to falls caused by entanglement in oxygen tubing. It is in this setting that we
now have an opportunity, as well as a challenge, to learn how best to improve care quality by de-implementing
a therapy that has no demonstrable benefit, is not without risk, but is deeply entrenched in clinical practice. To
address this knowledge gap, our proposed study aims to use a mixed-methods approach to inform VA about
their current practices for prescribing oxygen therapy to patients with COPD, as well as to identify anticipated
barriers and facilitators to its de-implementation among patients in whom it has been shown to be ineffective.
To achieve these goals, we will first identify a nationwide cohort of Veterans discharged with supplemental
oxygen after hospitalization for a COPD exacerbation and identify patient-, clinician- and system level factors
associated with appropriate reassessment of oxygen need within 90 days of discharge. We will then identify a
range of high- to low-performing sites in regards to timeliness of oxygen need reassessment. Using a
sequential mixed methods approach incorporating quantitative survey collection and in-depth qualitative
interviews, we will elicit patient and clinician perspectives on the discontinuation of supplemental oxygen
across a range of the high- and low-performing sites as well as at the sites of our planned intervention. Using
these initial results, we will develop, refine, and test a patient-, organizational-, and operational partner-
informed pilot intervention to increase value-based care by decreasing inappropriate oxygen use. We will
randomize 50 patients at two VA sites (VA Puget Sound and Bedford VA) to receive usual care or our de-
implementation intervention. In addition to assessing feasibility and acceptability of the intervention, we wi...

## Key facts

- **NIH application ID:** 10299667
- **Project number:** 5I01HX002499-04
- **Recipient organization:** VA PUGET SOUND HEALTHCARE SYSTEM
- **Principal Investigator:** Laura Cecere Feemster
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2021
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2018-07-01 → 2023-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10299667

## Citation

> US National Institutes of Health, RePORTER application 10299667, post-REcovery LIbEration From Oxygen in Exacerbated COPD (RELIEF) (5I01HX002499-04). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10299667. Licensed CC0.

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