Group Medical Visits in Heart Failure for Post-Hospitalization Follow-Up

心力衰竭患者出院后的团体医疗随访

基本信息

批准号：
10178103
负责人：
WEN-CHIH WU
金额：
--
依托单位：
PROVIDENCE VA MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2015
资助国家：
美国
起止时间：
2015-07-01 至 2020-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10178103
关键词：
Address Administrator American Area Behavior Cardiac Cardiac health Cardiomyopathies Caregivers Caring Case Management Cessation of life Chronic Disease Cities Clinical Nursing Clinical Pharmacists Complex Data Diabetes Mellitus Diet Discipline of Nursing Disease Disease Management Education Effectiveness Enrollment Ensure Environment Equilibrium Goals Health Health Professional Health Status Health system Heart failure Hospitalization Hospitals Hour Impaired health Intervention Interview Kansas Left Ventricular Ejection Fraction Literature Long-Term Care Measures Medical Medication Management Methods Modeling Monitor Morbidity - disease rate Nurse Practitioners Nurses Nutritionist Outcome Patient-Centered Care Patient-Focused Outcomes Patients Pharmaceutical Preparations Physicians Physiological Plasma Play Process Provider Psychologist Quality of Care Questionnaires Randomized Randomized Controlled Trials Research Research Project Grants Resources Risk Role Sampling Self Care Self Management Site System Team Nursing Telephone Interviews Testing Time Titrations Translating Veterans Visit base care delivery care outcomes chronic care model complex chronic conditions effectiveness trial experience follow-up group intervention health management hospital readmission improved improved outcome innovation medical appointment mortality multidisciplinary non-compliance nutrition peer support primary outcome programs secondary outcome success treatment as usual

项目摘要

DESCRIPTION (provided by applicant): The primary goal of this research project is to improve the health status and decrease hospitalization and death for patients discharged with heart failure (HF) via education to patients, disease monitoring and medication titration through shared medical appointments (SMAs). Studies have found patient self-care behaviors in HF (e.g. medication/dietary noncompliance) and health system factors (e.g. care discoordination, limited access, lack of education to patients and caregivers) played an important role in patient's health status and hospitalization risk to the extent that 50% of the readmissions were judged to be possibly/probably preventable. To address patient and system factors based on the Chronic Care Model, redesign of care delivery, via SMA's, can be a good solution to provide patient self- management support while also performing disease monitoring and medication management in an environment of peer support. We propose a randomized controlled trial to enroll patients within 6 weeks of discharge from a HF hospitalization and randomized them to receive either SMA intervention every other week for 8 weeks versus usual care for HF. We will determine, at 180 days from randomization, whether HF patients who participate in HF-SMA, as compared to patients who receive usual care: 1) Experience better cardiac health status measured by Kansas City Cardiomyopathy Questionnaire (primary outcome), and overall health status (EQ5D, secondary outcome); 2) Have fewer hospitalization or death and 3) Experience improvement in intermediate outcomes: a) increase in HF Self-Care behavior, and b) decrease in plasma BNP levels. For patients who underwent HF-SMA, we will also determine perceived benefits, areas in need of improvement, potential obstacles of implementation, and fidelity of the intervention across sites, by conducting (a) face-to-face interviews with patients and (b) telephone interviews with stakeholders (physicians of the patients and administrators). The sites will be Providence VA and Phoenix VA hospitals to enroll a total of 375 patients. The study duration will be 180 days for all patients from the time of randomization. We will use stratified (enrollment in other programs for HF care, <2 hospitalizations last 6 months, left ventricular ejection fraction <40%), block randomization with block sizes of 4 in each site to ensure balance of the stratified variables. The team will consist of a nutritionist, nurse, health psychologist an a clinical pharmacist or nurse practitioner, without the presence of a physician (cardiologist will b available on call). The session will start with an assessment of patient needs followed by pre-assigned theme-based disease self-management education, followed by patient-initiated disease management discussion, and conclude with break-out sessions of individualized medication case management. Our study findings will be used in health care management and system redesign to provide better quality and patient centered care for our veterans with HF. The long-term goal is to use a multi-disciplinary team approach in a group setting to manage HF support regular physician visits, in a peer support environment, all of which, are necessary to provide patient- centered care and improve outcomes.

描述（由申请人提供）：该研究项目的主要目标是通过患者自我教育、疾病监测和药物滴定来改善心力衰竭（HF）出院患者的健康状况并减少住院和死亡。 - 心力衰竭的护理行为（例如药物/饮食不合规）和卫生系统因素（例如护理不协调、获取机会有限、缺乏对患者和护理人员的教育）在一定程度上对患者的健康状况和住院风险发挥着重要作用50% 的再入院被认为是可能/可能可以预防的。为了解决基于慢性护理模型的患者和系统因素，通过 SMA 重新设计护理服务可能是一个很好的解决方案，可以提供患者自我管理支持，同时也可以提供帮助。我们建议开展一项随机对照试验，招募心衰住院后 6 周内的患者，并随机让他们每隔一周接受 SMA 干预，持续 8 周，与心力衰竭的常规护理进行比较。。我们将在随机分组后 180 天确定参与 HF-SMA 的心力衰竭患者与接受常规护理的患者相比是否：1) 通过堪萨斯城心肌病问卷（主要结果）测量的心脏健康状况和整体健康状况是否更好状态（EQ5D，次要结果）；2) 住院或死亡较少，3) 中间结果有所改善：a) 心力衰竭自我护理行为增加，b) 接受治疗的患者血浆 BNP 水平降低。 HF-SMA，我们还将通过 (a) 与患者面对面访谈和 (b) 与患者进行电话访谈来确定感知的益处、需要改进的领域、实施的潜在障碍以及跨地点干预的保真度。地点将是弗吉尼亚州普罗维登斯医院和弗吉尼亚州菲尼克斯医院，总共招募 375 名患者。从随机分组开始，所有患者的研究持续时间为 180 天。在其他方面心力衰竭护理计划、最近 6 个月内住院次数<2 次、左心室射血分数 <40%）、每个地点的分组大小为 4 的分组随机化，以确保分层变量的平衡该团队将由营养师、护士、健康人员组成。心理学家、临床药剂师或执业护士，无需医生在场（心脏病专家将随叫随到）。会议将首先评估患者需求，然后进行预先分配的基于主题的疾病自我管理教育。患者发起的疾病管理讨论，并以个性化药物病例管理的分组会议结束，我们的研究结果将用于医疗保健管理和系统重新设计，为患有心力衰竭的退伍军人提供更好的质量和以患者为中心的护理。长期目标是在小组环境中使用多学科团队方法来管理心力衰竭，并在同伴支持环境中支持定期医生就诊，所有这些对于提供以患者为中心的护理和改善结果都是必要的。