1/2 Video Telehealth Pulmonary Rehabilitation to Reduce Hospital Readmission in Chronic Obstructive Pulmonary Disease (Tele-COPD)

1/2 视频 远程医疗肺康复可减少慢性阻塞性肺疾病 (Tele-COPD) 的再入院率

• 批准号: 10505270
• 负责人: Surya P. Bhatt
• 金额: $ 180.22万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-01 至 2027-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10505270
• 关键词: Activities of Daily Living; Acute; Admission activity; Aerobic Exercise; Affect; Anti-Inflammatory Agents; Breathing Exercises; Bronchodilator Agents; Case Report Form; Chronic Obstructive Pulmonary Disease; Communities; Cost Savings; Data; Data Management Resources; Development; Disease; Dropout; Dyspnea; Economic Factors; Education; Effectiveness of Interventions; Enrollment; Equipment; Event; Exercise; Exercise Tolerance; Feedback; Fees; Focus Groups; Functional disorder; Geographic Locations; Health; Health Care Costs; Healthcare; Home; Hospitalization; Hospitals; Insurance Coverage; Intervention; Length of Stay; Lung; Manuals; Medical; Monitor; Moods; Morbidity - disease rate; Multi-Institutional Clinical Trial; Multicenter Trials; Online Systems; Outcome; Oxidative Stress; Patients; Pharmaceutical Preparations; Phase; Procedures; Protocols documentation; Quality of life; Quality-Adjusted Life Years; Randomized; Randomized Controlled Trials; Recovery of Function; Rehabilitation Centers; Reporting; Resource-limited setting; Resources; Safety; Self Efficacy; Service delivery model; Skeletal Muscle; Stress; Symptoms; Testing; Time; Transportation; United States; Visit; Walking; biological adaptation to stress; care delivery; comparative cost effectiveness; comparative efficacy; cost; cost effective; cost-effectiveness evaluation; cost-effectiveness ratio; deconditioning; exercise capacity; follow-up; functional status; hospital readmission; improved; incremental cost-effectiveness; indexing; muscle strength; prevent; programs; prospective; psychologic; pulmonary rehabilitation; readmission rates; readmission risk; resilience; respiratory; respiratory morbidity; rural area; rural patients; secondary outcome; social; socioeconomics; standard of care; strength training; symptom treatment; telehealth; trial comparing; underserved rural area; uptake; urban area; urban underserved

Project Summary/Abstract Acute exacerbations of chronic obstructive pulmonary disease (COPD) result in significant morbidity and healthcare costs, especially severe exacerbations that require hospitalization. Traditional bronchodilators and anti- inflammatory medications, as well as programs to monitor and treat symptoms, have a modest effect on reducing hospital admissions. Readmission rates remain unacceptably high, so alternative approaches are needed. In this regard, pulmonary rehabilitation (PR) is remarkably effective, and is associated with an 80% reduction in admission rates. Successful completion of PR is also associated with substantial improvements in quality of life, dyspnea, as well as exercise tolerance. Despite these benefits, recent studies have highlighted very poor referral rates for PR overall and as low as 1.9% post-hospitalization, and non-completion rates as high as 60%. The poor adaptation of PR in the community is due to a combination of barriers in availability and accessibility, as well as attrition. The number of PR centers in the United States is inadequate, and these centers are mostly distributed in urban areas. In addition, multiple socioeconomic and medical barriers hinder access to PR, and contribute to high drop-out rates. New strategies are needed to reduce hospital readmission in COPD, and to increase the delivery of PR to underserved urban as well as rural areas in the community. Given the scarcities in existing resources, conventional models of care delivery are being challenged, and attempts are being made to find alternative, cost-effective ways of delivering healthcare to a larger number of eligible patients. To overcome the socioeconomic and physical barriers to PR, we hypothesize that a video telehealth intervention that will deliver PR to the patient's home, regardless of geographic location, will reduce hospital readmissions in COPD, and reduce respiratory morbidity. To test our hypothesis we propose a prospective randomized controlled phase 3 multicenter clinical trial comparing a real-time video telehealth PR intervention plus standard of care versus standard of care alone, with the following Specific Aims: (1) To determine if a video telehealth PR intervention reduces 30-day all-cause readmissions in patients hospitalized for acute exacerbation of COPD, (2) To evaluate the effects of the video telehealth PR intervention on dyspnea and respiratory quality of life in COPD post hospital discharge, and (3) To evaluate the cost-effectiveness of the telehealth intervention. Accomplishment of the aims of this study will result in a significant reduction in COPD readmission rates, and a paradigm shift in the way PR is delivered to patients with COPD, especially those that reside in remote and rural areas with limited access to pulmonary rehabilitation.

项目概要/摘要 慢性阻塞性肺疾病（COPD）急性加重会导致显着的发病率和 医疗费用，特别是需要住院治疗的严重恶化。传统支气管扩张剂和抗支气管扩张剂 炎症药物以及监测和治疗症状的方案对减少炎症有一定作用 医院入院。再入院率仍然高得令人无法接受，因此需要替代方法。在这个 肺康复 (PR) 非常有效，入院人数减少 80% 费率。成功完成 PR 还与生活质量、呼吸困难的显着改善相关，例如 还有运动耐力。尽管有这些好处，但最近的研究强调公关转介率非常低 总体而言，住院后的死亡率低至 1.9%，未完成率高达 60%。适应性较差 社区中的公关是由于可用性和可访问性方面的障碍以及人员流失造成的。这 美国的公关中心数量不足，而且这些中心大多分布在城市地区。 此外，多重社会经济和医疗障碍阻碍了获得永久居民的机会，并导致高辍学率。 需要新的策略来减少 COPD 患者的再入院率，并增加 PR 的实施 社区中服务不足的城市和农村地区。鉴于现有资源的稀缺性，传统 护理服务模式正在受到挑战，人们正在尝试寻找替代的、具有成本效益的方式 为更多符合条件的患者提供医疗保健。克服社会经济和身体上的困难 由于公关的障碍，我们假设视频远程医疗干预可以将公关带到患者家中， 无论地理位置如何，都将减少慢性阻塞性肺病的再入院率，并降低呼吸道疾病的发病率。到 检验我们的假设，我们提出了一项前瞻性随机对照 3 期多中心临床试验，比较 实时视频远程医疗公关干预加上标准护理与单独标准护理的对比，其中包括以下内容 具体目标：(1) 确定视频远程医疗公关干预是否可以减少 30 天全因再入院率 因 COPD 急性加重住院的患者，(2) 评估视频远程医疗 PR 的效果 对 COPD 出院后呼吸困难和呼吸生活质量进行干预，以及 (3) 评估 远程医疗干预的成本效益。本研究目标的实现将产生重大成果 降低 COPD 再入院率，以及向 COPD 患者提供 PR 方式的范式转变， 尤其是那些居住在偏远和农村地区、获得肺康复机会有限的人。