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：
10176583
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/10176583
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的是通过对患者进行教育，疾病监测和药物滴定通过共同的医疗任命（SMA）来改善患有心力衰竭（HF）的患者的健康状况，并减少住院和死亡。研究发现，患者在HF（例如药物/饮食不合规）和卫生系统因素（例如，护理不及不及，有限的访问，对患者和护理人员缺乏教育）在患者的健康状况和住院风险中起着重要的作用，其判断为50％的复习是可能的/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的重新设计护理交付可以是提供患者自我管理支持的良好解决方案，同时在同伴支持的环境下还进行疾病监测和药物管理。我们提出了一项随机对照试验，以在HF住院后6周内招募患者，并随机将每隔一周的SMA干预持续8周，而对HF的通常护理。与接受常规护理的患者相比，我们将在从随机化的180天后确定是否参加HF-SMA的HF患者：1）经历堪萨斯城市心肌病态调查表（主要结果）和整体健康状况（EQ5D，次要结果）衡量的更好的心脏健康状况； 2）住院或死亡较少，3）中级结果的经验改善：a）HF自我保健行为的增加，b）血浆BNP水平的降低。对于接受HF-SMA的患者，我们还将通过（a）对患者进行面对面的面试，以及（b）与利益相关者（患者和管理员的医生）进行电话采访，还将确定感知到的福利，需要改善的领域，潜在的实施障碍以及跨站点干预的忠诚度。这些地点将是普罗维登斯VA和凤凰VA医院，总共招募375名患者。从随机化开始，所有患者的研究持续时间将为180天。我们将使用分层（其他用于HF护理的计划的注册，过去6个月<2个住院，左心室射血分数<40％），在每个站点中的块随机化，块大小为4，以确保分层变量的平衡。该团队将由营养学家，护士，健康心理学家成为临床药剂师或护士从业者，而没有身体（心脏病专家将在呼叫上可用）。该会议将从对患者需求进行评估，然后进行预先分配的基于主题的疾病自我管理教育，然后进行患者发起的疾病管理讨论，并包含分类的个性化药物治疗病例管理。我们的研究结果将用于医疗保健管理和系统重新设计，以为我们的HF提供更好的质量和患者护理。长期的目标是在小组环境中使用多学科团队方法来管理HF的定期身体访问，在同伴支持环境中，所有这些都是为了提供以患者为中心的护理和改善结果所必需的。