Improving Participation in Cardiac Rehabilitation among Lower-Socioeconomic Status Patients: Efficacy of Early Case Management and Financial Incentives

提高社会经济地位较低的患者对心脏康复的参与：早期病例管理和经济激励的有效性

• 批准号: 10470236
• 负责人: PHILIP A. ADES
• 金额: $ 71.51万
• 依托单位: UNIVERSITY OF VERMONT & ST AGRIC COLLEGE
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-08-25 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10470236
• 关键词: Accounting; Adherence; Adopted; Aftercare; Anxiety; Appointments and Schedules; Asthma; Biochemical; Body Weight decreased; Cardiac; Cardiac rehabilitation; Cardiovascular system; Caring; Case Management; Case Manager; Characteristics; Cocaine Dependence; Coronary Artery Bypass; Cost Savings; Data; Diabetes Mellitus; Dose; Economically Deprived Population; Emergency department visit; Enrollment; Event; Evidence based intervention; HIV; Health; Health behavior; Hospitalization; Hospitals; Incentives; Individual; Intervention; Knowledge; Life; Life Stress; Literature; Medical; Medical Care Costs; Mental Depression; Modeling; Monitor; Morbidity - disease rate; Myocardial Infarction; Nature; Nurses; Obesity; Operative Surgical Procedures; Outcome; Outpatients; Participant; Patients; Pharmaceutical Preparations; Population; Quality of life; Randomized; Randomized Controlled Trials; Recommendation; Reduce health disparities; Research; Risk; Severities; Smoking; Symptoms; Techniques; Treatment Effectiveness; Treatment Efficacy; Underserved Population; Unhealthy Diet; Vulnerable Populations; adherence rate; base; cardiovascular risk factor; care coordination; coronary event; cost; cost effectiveness; cost-effectiveness evaluation; disadvantaged population; efficacy evaluation; efficacy testing; executive function; financial incentive; fitness; follow-up; health disparity; health economics; health related quality of life; high risk; hospital readmission; improved; intervention cost; low socioeconomic status; mortality; programs; readmission rates; smoking cessation; smoking during pregnancy; standard of care; success; symptom management; treatment as usual

PROJECT SUMMARY Participation in outpatient cardiac rehabilitation (CR) decreases morbidity and mortality for patients hospitalized with myocardial infarction, coronary bypass surgery or percutaneous revascularization. Unfortunately, only 10- 35% of patients for whom CR is indicated choose to participate. Lower socioeconomic status (SES) is a robust predictor of CR non-participation. There is growing recognition of the need to increase CR among economically disadvantaged patients, but there are almost no evidence-based interventions available for doing so. In the present study we are examining the efficacy of using early case management and financial incentives for increasing CR participation among lower-SES patients. Case management has been effective at promoting attendance at a variety of health-related programs (e.g. treatment for diabetes, HIV, asthma, cocaine dependence) as well as reducing hospitalizations. Financial incentives are also highly effective in altering health behaviors among disadvantaged populations (e.g., smoking during pregnancy, weight loss) including CR participation in our prior trial. For this study we will randomized 200 CR-eligible lower-SES patients to: a treatment condition where there are assigned a case manager while in hospital who will facilitate CR attendance and coordinate cardiac care, a treatment condition where they receive financial incentives contingent on initiation of and continued attendance at CR sessions, a combination of these two interventions, or to a “usual-care” condition. Participants in all conditions will complete pre- and post-treatment assessments. Treatment conditions will be compared on attendance at CR and end-of-intervention improvements in fitness, executive function, and health-related quality of life. Cost effectiveness of the treatment conditions will also be examined by comparing the costs of delivering the interventions and the usual care condition taking into account increases in CR participation. Furthermore, we will model the value of the interventions based on increases in participation rates, intervention costs, long-term medical costs, and health outcomes after a coronary event. This systematic examination of promising interventions will allow us to test the efficacy and cost-effectiveness of approaches that have the potential to substantially increase CR participation and significantly improve health outcomes among lower-SES cardiac patients.

项目摘要 参加门诊心脏康复（CR）会降低住院的患者的发病率和死亡率 带有心肌梗塞，冠状动脉搭桥手术或经皮血运重建。不幸的是，只有10- 35％的CR的患者选择参加。较低的社会经济地位（SES）是一个强大的 人们对在经济上增加CR的需求的认识日益认识到 处境不利的患者，但几乎没有可供证据的干预措施。在 目前的研究我们正在研究使用早期案例管理和经济激励措施的有效性 较低SES患者的CR参与增加。案件管理一直有效促进 参加各种与健康有关的计划（例如，糖尿病，艾滋病毒，哮喘，可卡因治疗 依赖）以及减少住院治疗。经济激励措施也非常有效地改变 灾难人群中的健康行为（例如，怀孕期间吸烟，减肥） CR参与我们的先前审判。在这项研究中，我们将将200个符合CR的低SES患者随机分配给： 在医院期间分配了一个病例经理的治疗条件，该病例经理将促进CR 出勤和协调心脏护理，这是他们收到经济激励措施的治疗条件 取决于启动并继续参加Cr会议，这两种干预措施的结合， 或达到“通常的护理”条件。所有情况下的参与者将完成治疗前和治疗后的评估。 将比较治疗条件的CR和健身终止改善的出勤情况， 执行功能和与健康相关的生活质量。治疗条件的成本效益也将是 通过比较提供干预措施的成本和通常的护理条件来检查 CR参与的帐户增加。此外，我们将基于 参与率的提高，干预成本，长期医疗费用和健康状况 冠状动脉事件。对承诺干预措施的系统检查将使我们能够测试效率和 有可能大大增加参与和的方法的成本效益 大幅SES心脏患者的健康状况显着改善。

项目成果

Anxiety Predicts Worse Cardiorespiratory Fitness Outcomes in Cardiac Rehabilitation for Lower Socioeconomic Status Patients.

焦虑预示着社会经济地位较低的患者在心脏康复中心肺健康结果会更差。

• DOI: 10.1097/hcr.0000000000000852
• 发表时间: 2024
• 期刊: Journal of cardiopulmonary rehabilitation and prevention
• 影响因子: 3.8
• 作者: Middleton,WilliamA;Savage,PatrickD;Khadanga,Sherrie;Rengo,JasonL;Ades,PhilipA;Gaalema,DiannE
• 通讯作者: Gaalema,DiannE

The Association of Patient Educational Attainment With Cardiac Rehabilitation Adherence and Health Outcomes.

• DOI: 10.1097/hcr.0000000000000646
• 发表时间: 2022-07-01
• 期刊: Journal of cardiopulmonary rehabilitation and prevention
• 影响因子: 3.8

Update on RFA Increasing Use of Cardiac and Pulmonary Rehabilitation in Traditional and Community Settings NIH-Funded Trials: ADDRESSING CLINICAL TRIAL CHALLENGES PRESENTED BY THE COVID-19 PANDEMIC.

关于 RFA 在传统和社区环境中增加 NIH 资助试验中心肺康复的使用的最新信息：解决 COVID-19 大流行带来的临床试验挑战。

• DOI: 10.1097/hcr.0000000000000635
• 发表时间: 2022
• 期刊: Journal of cardiopulmonary rehabilitation and prevention
• 影响因子: 3.8
• 作者: Shero,SusanT;Benzo,Roberto;Cooper,LawtonS;Finkelstein,Joseph;Forman,DanielE;Gaalema,DiannE;Joseph,Lyndon;Keteyian,StevenJ;Peterson,PamelaN;Punturieri,Antonello;Zieman,Susan;Fleg,JeromeL
• 通讯作者: Fleg,JeromeL

Examining Associations Between Baseline Health-Related Quality of Life and Depression and Physical Functioning Improvement Following Pulmonary Rehabilitation.

检查基线健康相关生活质量与抑郁症和肺康复后身体功能改善之间的关联。

• DOI: 10.1097/hcr.0000000000000844
• 发表时间: 2024
• 期刊: Journal of cardiopulmonary rehabilitation and prevention
• 影响因子: 3.8
• 作者: Coleman,SulamunnRM;Menson,KatherineE;Katz,BrianR;DeSarno,MichaelJ;Gaalema,DiannE
• 通讯作者: Gaalema,DiannE

Self-Reported Executive Function in Hospitalized Cardiac Patients and Associations With Patient Characteristics and Cardiac Rehabilitation Attendance.

住院心脏病患者自我报告的执行功能以及与患者特征和心脏康复就诊的关联。

• DOI: 10.1097/hcr.0000000000000785
• 发表时间: 2023
• 期刊: Journal of cardiopulmonary rehabilitation and prevention
• 影响因子: 3.8
• 作者: Katz,BrianR;Khadanga,Sherrie;Middleton,WilliamA;Mahoney,Katharine;Savage,PatrickD;DeSarno,Michael;Ades,PhilipA;Gaalema,DiannE
• 通讯作者: Gaalema,DiannE