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.

项目摘要/摘要 慢性阻塞性肺疾病（COPD）的急性加重导致明显的发病率和 医疗保健费用，尤其是严重的恶化，需要住院。传统的支气管扩张剂和抗 炎症药物以及监测和治疗症状的程序，对减少 住院入院。再入院率仍然不可接受，因此需要替代方法。在这个 考虑到肺康复（PR）非常有效，并且降低了80％ 费率。成功完成PR还与生活质量的大幅改善有关，呼吸困难 以及运动耐受性。尽管有这些好处，但最近的研究突显了PR的转介率很差 总体而言，总院后1.9％，不完整率高达60％。不良改编 社区中的PR是由于可用性和可及性障碍以及损耗的结合。这 美国的公关中心数量不足，这些中心主要分布在城市地区。 此外，多个社会经济和医疗障碍阻碍了PR的通道，并导致了高辍学率。 需要采取新的策略来减少COPD中的医院再入院，并增加公关的交付 社区中服务不足的城市和农村地区。鉴于现有资源的稀缺，常规 护理交付模式正在受到挑战，并正在尝试寻找替代性，成本效益的方式 向更多合格患者提供医疗保健。克服社会经济和身体 PR的障碍，我们假设视频远程医疗干预将为患者的家提供PR 无论地理位置如何，都会减少COPD中的医院再入院，并降低呼吸道发病率。到 检验我们的假设，我们提出了一项前瞻性随机控制阶段3多中心临床试验，比较 实时视频远程医疗PR干预加上护理标准与护理标准，以下 具体目的：（1）确定视频远程医疗PR干预是否减少了30天的全因再入院 患者因急性加重COPD住院，（2）评估视频远程医疗PR的影响 COPD医院出院后的呼吸困难和呼吸质量的干预，（3）评估 远程医疗干预的成本效益。实现这项研究的目标将导致重大 降低COPD再入院率，以及将PR传递给COPD患者的方式的范式转变， 尤其是那些居住在偏远和农村地区的肺部康复。