Rehabilitation in Safety-Net Environments (RISE) for COPD

慢性阻塞性肺病安全网环境康复 (RISE)

基本信息

批准号：
10557812
负责人：
Neeta Thakur
金额：
$ 68.83万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-02-01 至 2027-01-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10557812
关键词：
Address Adherence Adoption Advocate Affect Body Weight Caring Cause of Death Chronic Obstructive Pulmonary Disease Clinic Clinical Clinical Trials Communities Control Groups County Coupled Disease Disease Outcome Educational process of instructing Elements Enrollment Environment Equipment Evidence based intervention Evidence based program Exercise Face Geographic Locations Geography Goals Health Health Benefit Health Resources Healthcare Systems Hospitalization Individual Intervention Interview Leadership Life Link Low income Maintenance Medicare Methods Mission Monitor Morbidity - disease rate Neighborhoods Outcome Oxygen Participant Pathway interactions Patients Population Primary Care Process Qualitative Methods Quality of life Randomized Reach, Effectiveness, Adoption, Implementation, and Maintenance Rehabilitation Centers Rehabilitation therapy Resources Risk Reduction San Francisco Self Management Services Site Social Environment Social support Structure Symptoms Testing Underinsured Vulnerable Populations Waiting Lists Walking arm beneficiary contextual factors cost design economic disparity effective intervention effectiveness evaluation effectiveness testing effectiveness/implementation design evidence base exercise training experience food insecurity functional decline functional improvement functional outcomes health care settings heart rate monitor high risk housing instability implementation barriers implementation evaluation implementation intervention improved improved outcome innovation intervention delivery intervention effect low health literacy neighborhood disadvantage older patient patient engagement patient population patient-level barriers peer pilot trial portability post intervention preservation primary outcome programs pulmonary rehabilitation resistance exercise safety net screening secondary outcome social social vulnerability stressor symptomatic improvement system-level barriers three-arm trial treatment as usual

项目摘要

Project Abstract Individuals with moderate-to-severe chronic obstructive pulmonary disease (COPD) are at high risk for rapid functional decline and hospitalization. Pulmonary rehabilitation is one of the few interventions that has been shown to effectively modify the course of COPD and improve health outcomes; however, challenges in implementation and access to this high resource intervention in real-life settings have led to low-availability and engagement due to both healthcare system-level and patient-level barriers. To address barriers specific to low- resourced healthcare settings, we developed COPD Wellness with patient and clinical stakeholders. This 10- week community-based program retains key elements of pulmonary rehabilitation (exercise training, self- management, and peer social support), but is designed to be portable and feasible to deliver in diverse settings. While COPD Wellness addresses many system-level barriers, it does not directly address patient-level barriers. Lower levels of adherence are common across low-income, low health literacy communities, reflecting the burden of competing socio-environmental stressors that interfere with the ability to carry out rehabilitation activities and independently contribute to poor outcomes in COPD. We adapted the evidence-based resource support program, Health Advocates (HA), for the unmet social needs of older patients with COPD as a strategy to improve acceptance, adherence, and impact of pulmonary rehabilitation programs (Plus+). The proposed study will directly test the benefit of the COPD Wellness and Plus+ Program relative to usual care and estimate the added benefit of the HA in COPD Wellness Plus+ to COPD Wellness alone in a three-arm, randomized waitlist-controlled trial conducted in three geographically isolated urban primary care sites that provide care for some of the most socially vulnerable patient populations with COPD. In this Type 1 effectiveness- implementation hybrid design, we aim to 1) determine the effectiveness of COPD Wellness and Plus+ to improve functional and symptom outcomes; and, using a mixed-methods approach 2) to evaluate the implementation of COPD Wellness and Plus+ across study sites applying the RE-AIM and CFIR frameworks to identify additional barriers and enablers of intervention implementation and patient acceptance and adherence. COPD Wellness Plus+ was designed to specifically address barriers to rehabilitation and function within low-resourced healthcare settings. If effective, the COPD Wellness Plus+ program can offer a feasible pathway for broader implementation of low intensity pulmonary rehabilitation regionally and nationally in the U.S.

项目摘要患有中度至重度慢性阻塞性肺疾病（COPD）的个体迅速有高风险功能下降和住院。肺康复是少数几次干预措施之一显示出有效修改COPD的过程并改善健康结果；但是，挑战在现实生活中实施和访问这种高资源干预已导致低可用性和由于医疗保健系统级别和患者级障碍而引起的参与。解决特定于低 - 的障碍资源丰富的医疗机构，我们与患者和临床利益相关者开发了COPD健康。这个10- 基于社区的周计划保留肺部康复的关键要素（运动训练，自我训练管理和同行社会支持），但旨在便携式和可行，可以在不同的环境中交付。尽管COPD健康解决了许多系统级障碍，但它并未直接解决患者级别的障碍。较低的依从性在低收入，低健康素养社区中很常见，反映了竞争社会环境压力的负担，这些压力源干扰进行康复的能力活动并独立促进COPD的不良结果。我们调整了基于证据的资源支持计划，健康倡导者（HA），供老年患者COPD的未满足的社会需求作为策略提高肺部康复计划的接受，依从性和影响（加+）。拟议的研究将直接测试COPD健康的好处，而Plus+计划相对于通常的护理并估计HA在COPD Wellness Plus++ COPD健康中的额外益处仅在三臂在三个地理孤立的城市初级保健网站上进行的随机候补候补程序对照试验用COPD为一些最脆弱的患者群体提供护理。在此类型1中有效性 - 实施混合设计，我们的目标是1）确定COPD健康和加上+的有效性以提高功能和症状结果；并且，使用混合方法方法2）评估 COPD健康和加+在研究网站上应用RE-AIM和CFIR框架以识别其他干预实施以及患者接受和依从性的障碍和推动者。 COPD健康 Plus+旨在专门解决低资源医疗保健中康复和功能的障碍设置。如果有效，COPD Wellness Plus+计划可以为更广泛的实施提供可行的途径在美国，低强度的肺部康复和全国范围内