Vet-COACH (Veteran peer Coaches Optimizing and Advancing Cardiac Health)

Vet-COACH（优化和促进心脏健康的资深同行教练）

• 批准号: 10186477
• 负责人: KARIN M. NELSON
• 金额: --
• 依托单位: VA PUGET SOUND HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-03-01 至 2023-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10186477
• 关键词: Adoption; Alcohol consumption; Blood Pressure; Cardiac health; Cardiovascular Diseases; Caring; Case Manager; Characteristics; Chronic; Chronic Disease; Clinic; Communities; Community Health Aides; Community Outreach; Comprehensive Health Care; Cost Analysis; Data; Disease; Eating; Education; Emergency department visit; Enrollment; Future; Goals; Health; Health Benefit; Health Care Costs; Health Promotion; Health behavior; Health behavior change; Health education; Health system; Healthcare; Healthcare Systems; High Prevalence; Home; Home visitation; Hospitalization; Hybrids; Hyperlipidemia; Hypertension; Individual; Intervention; Life Experience; Link; Lipids; Literature; Measures; Medical; Mental Health; Modeling; Morbidity - disease rate; Motivation; Nursing Care Management; Obesity; Outcome; Overweight; Patient-Centered Care; Patients; Pharmacists; Pharmacy facility; Physical activity; Population; Prevalence; Prevention program; Primary Health Care; Randomized; Randomized Controlled Trials; Reporting; Resources; Risk; Risk Factors; Risk Reduction; Self Management; Services; Smoke; Social support; Telephone; Testing; Tobacco use; Training; Unhealthy Diet; United States Department of Veterans Affairs; Veterans; Work; base; behavior change; cardiovascular disorder risk; cardiovascular risk factor; care providers; communication behavior; community clinic; cost; cost effective; disorder prevention; effectiveness testing; evidence base; follow-up; health care service utilization; health related quality of life; healthy lifestyle; high risk population; hypertension control; implementation study; improved; intervention cost; medication compliance; modifiable risk; mortality; nutrition; patient-clinician communication; peer; peer coaching; peer support; primary outcome; programs; satisfaction; secondary outcome; sedentary; social; stress management

 DESCRIPTION (provided by applicant): BACKGROUND: Cardiovascular disease (CVD) is the leading cause of mortality among Veterans, and suboptimal risk factor control is an important mechanism for the continued prevalence of CVD. Despite clinic based programming that includes nurse care management, pharmacy support, telephone care programs and intensive quality improvement efforts, CVD risk factors remain sub-optimally controlled among Veterans. Given the high prevalence and cost CVD within the Department of Veterans Affairs, cost-effective mechanisms are needed to manage the burden of prevalent CVD risk factors. Veteran peer health coaches may be one such mechanism; however, previous work has provided limited data of this model with VHA primary care. Previous studies of peer support in non-VHA populations report significant improvement in hypertension control and CVD risk reduction. OBJECTIVES: The proposed project will test the effectiveness of Vet-COACH (Veteran peer Coaches Optimizing and Advancing Cardiac Health), a peer health coaching program to help reduce CVD risk among Veterans. The overall goal of this study is to test the effectiveness of a home-visit peer health coach intervention to promote health behavior change among Veterans with multiple CVD risk factors with a hybrid type 1 implementation study. To target a high risk population, we will focus on Veterans with poorly controlled hypertension and at least one other CVD risk factor. METHODS: We will conduct a randomized controlled trial that will enroll n=590 Veterans to compare a peer health coach intervention consisting of home visits, telephone support, and linkages to appropriate community-based and clinic resources compared to usual VHA primary care. The primary outcome is reduction in systolic blood pressure from baseline to follow-up at 1-year. Secondary outcomes include a reduction in Framingham Cardiovascular risk score, individual cardiovascular risks (tobacco use, lipids), health related quality of life and health cae use. We will also assess the effects of the peer health coach intervention on intermediate outcomes including social support, patient activation, patient/provider communication and health behaviors (e.g. medication adherence, physical activity, nutrition, alcohol use, and stress management). In addition, we will assess the cost of the intervention to inform feasibility for future studies, determine Veteran and staff satisfaction with the intervention, and identify barriers and facilitators to adoption. IMPACT ON VETERANS HEALTH CARE: Integrating peer health coaches into PACT primary care teams may improve the VA's ability to provide community outreach to Veterans. CVD risk reduction provides an ideal target for intervention given the prevalence of modifiable risks among Veterans. The proposed study will increase understanding of the utilization of peer support within PACT teams. If this study proves the main hypothesis, this evidence-based support model could be tested more widely among Veterans with other chronic conditions to improve health outcomes.

 描述（由申请人提供）： 背景：心血管疾病（CVD）是退伍军人死亡的主要原因，尽管基于临床的规划包括护士护理管理、药房支持、电话护理计划和重症监护，但风险因素控制不佳是 CVD 持续流行的重要机制。尽管在质量改进工作中，退伍军人中的 CVD 风险因素仍未得到最佳控制，但鉴于退伍军人事务部内 CVD 的患病率较高且成本较高，因此需要具有成本效益的机制来管理退伍军人同伴健康​​教练可能面临的负担。是一种这样的机制；然而，之前的工作提供了有关 VHA 初级保健模型的有限数据。 之前对非 VHA 人群的同伴支持的研究报告了高血压控制和 CVD 风险降低的显着改善。 Vet-COACH（优化和促进心脏健康的退伍军人同伴教练）的有效性，这是一项帮助降低退伍军人心血管疾病风险的同伴健康辅导计划。本研究的总体目标是测试家访同伴健康的有效性。通过混合 1 型实施研究，指导干预措施促进具有多种 CVD 危险因素的退伍军人的健康行为改变。为了针对高风险人群，我们将重点关注高血压控制不佳和至少一种其他 CVD 危险因素的退伍军人。将进行一项随机对照试验，招募 590 名退伍军人，以比较同伴健康教练干预措施（包括家访、电话支持以及与适当的社区和诊所资源的联系）与通常的 VHA 初级保健相比，主要结果是减少。在收缩期次要结果包括弗雷明汉心血管风险评分的降低、个人心血管风险（吸烟、血脂）、健康相关的生活质量和健康护理的使用。同伴健康教练干预对中间结果的影响，包括社会支持、患者激活、患者/提供者沟通和健康行为（例如药物依从性、身体活动、营养、饮酒和压力管理）。此外，我们将评估这些干预的成本。干预以告知确定未来研究的可行性，确定退伍军人和工作人员对干预措施的满意度，并确定对退伍军人医疗保健的影响的障碍和促进因素：将同伴健康教练纳入 PACT 初级保健团队可能会提高 VA 为退伍军人提供社区服务的能力。鉴于退伍军人中存在可改变的风险，降低风险提供了一个理想的干预目标。如果这项研究证明了主要假设，那么这项基于证据的支持模型将增加对 PACT 团队内同伴支持的利用的理解。可以在患有其他慢性病的退伍军人中进行更广泛的测试，以改善健康结果。