Promoting Self-management Through Adherence among Heart Failure Patients

通过心力衰竭患者的依从性促进自我管理

基本信息

批准号：
8573521
负责人：
Lufei Young
金额：
$ 30.1万
依托单位：
UNIVERSITY OF NEBRASKA MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-08-07 至 2016-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8573521
关键词：
Accounting Acute Address Adherence Adult Advanced Practice Nurse Age-Years Appointment Behavior Behavioral Biological Markers Brain natriuretic peptide Caring Chronic Clinical Clinical Trials Control Groups Creatinine Data Data Collection Economic Burden Education Educational Intervention Effectiveness Effectiveness of Interventions Enrollment Evaluation Exercise Family Foundations Future Guidelines Health Health Benefit Healthcare Healthcare Systems Heart failure Home environment Hospitalization Hospitals Intervention Knowledge Life Measures Methods Monitor Morbidity - disease rate Nursing Theory Outcome Patient Discharge Patient Self-Report Patients Persons Pharmaceutical Preparations Phase Prevalence Provider Randomized Controlled Trials Readiness Recruitment Activity Reporting Research Resources Rural Rural Community Rural Hospitals Sample Size Self Efficacy Self Management Services Sodium Solutions Specialist Telephone Testing Time Translating Urban Health Urban Hospitals Urine Vulnerable Populations Weight Work base critical access hospital dietary restriction efficacy testing group intervention hospital readmission improved innovation intervention program mortality primary outcome programs prospective public health relevance skills theories therapy design treatment as usual willingness

项目摘要

DESCRIPTION (provided by applicant): Heart failure (HF) is among the most prevalent chronic conditions and leading cause of hospital readmission in adults 65 years of age and older. HF patients discharged from rural critical access hospitals (CAHs) had higher 30-day readmission rates compared to patients discharged from urban hospitals. Adhering to recommended self-management behaviors improves HF patients' health outcomes and reduces readmissions; however, the prevalence of adherence is low in HF patients. In rural communities, low adherence can be attributed to the fact that rural HF patients received less information about managing their chronic condition based on our preliminary study. Previous studies reported inconsistent findings regarding the effectiveness of interventions designed to improve self-management adherence. The feasibility of these interventions in rural settings is unknown. Therefore, innovative programs are needed to identify the intervention to enhance self-management adherence in HF patients living in rural communities. The purpose of this prospective, two-group, repeated measures, randomized control trial is to test the efficacy and feasibility of a 12-week activation-enhancing intervention (Patient Activated Care at Home [PATCH]) on self-management adherence and health outcome (readmission rates) in HF patients discharged from rural hospitals (critical access hospitals). A sample size of 96 subjects with heart failure will be recruited over 14 month period. Both intervention and control groups will receive usual care. The intervention group will additionally receive 2-phase PATCH intervention: the in-hospital discharge education session (Phase I) and 12-week post-discharge education sessions delivered by telephone (Phase II). The tailored strategies are developed to activate patients engaging in self-management behaviors based on their baseline activation level. Our central hypothesis, based upon our preliminary data, is that patients with higher activation level will have significantly better self-management adherence. We will test our hypothesis with the following Specific Aims: To evaluate the effects of the patient activation intervention on self-management adherence (Aim 1) and hospital readmissions (Aim 2) over time. To evaluate the mechanism of the patient activation intervention (Aim 3). To evaluate the feasibility of the PATCH intervention (Aim 4). The PATCH intervention is innovative because: 1) it translates patient activation theory into intervention strategies to improve self-management in a vulnerable population (rural heart failure patients living in rural community), 2) it tests the mechanism of patient activation on self-management adherence; 3) it uses the rural nursing theory to guide developing a sustainable intervention program in rural communities; and 4) it evaluates a biomarker collected by a single urine test as the indicator of self-management adherence in HF patients. This study will impact the management of heart failure by adding knowledge about the mechanism to improve self-management adherence in heart failure patient living in rural communities. Long term adherence to the recommended self-management behaviors is the foundation to realize health benefit and reduce burden on patients, their family and the healthcare system.

描述（由申请人提供）：心力衰竭（HF）是65岁及以上的成年人最普遍的慢性病和医院再入院的主要原因之一。与从城市医院出院的患者相比，从农村关键入院医院（CAHS）出院的HF患者的30天再入院率更高。坚持推荐的自我管理行为可以改善HF患者的健康结果并减少重新入学；但是，HF患者的依从性较低。在农村社区中，基于我们的初步研究，较低的依从性可以归因于农村HF患者收到有关管理其慢性病的信息。先前的研究报告了有关旨在提高自我管理依从性的干预措施的有效性的发现不一致的结果。这些干预措施在农村环境中的可行性尚不清楚。因此，需要创新计划来确定干预措施，以增强农村社区中HF患者的自我管理遵守。这项前瞻性，两组重复措施的目的是随机对照试验是为了测试12周激活增强干预干预措施（家里的患者激活护理[Patch]）对自我管理依从性和健康结果（再入院率）的疗效和可行性。在14个月内，将招募96名患有心力衰竭的受试者的样本量。干预和对照组都将获得常规护理。干预小组还将接受2阶段的补丁干预：院内出院教育课程（I阶段）和通过电话（II阶段）提供的12周的入院后教育课程。量身定制的策略是为了激活基于基线激活水平的自我管理行为的患者的开发。基于我们的初步数据，我们的中心假设是，激活水平较高的患者将具有更好的自我管理依从性。我们将以以下特定目的检验假设：评估患者激活干预对自我管理依从性（AIM 1）和医院再入院（AIM 2）的影响。评估患者激活干预的机制（AIM 3）。评估斑块干预的可行性（AIM 4）。补丁干预具有创新性，因为：1）它将患者激活理论转化为改善弱势人群的自我管理的干预策略（农村心力衰竭患者生活在农村社区中），2）它测试了患者激活自我管理依从性的机制； 3）它使用农村护理理论来指导在农村社区制定可持续干预计划； 4）它评估了通过单个尿液测试收集的生物标志物，作为HF患者自我管理依从性的指标。这项研究将通过增加有关改善农村社区心力衰竭患者自我管理遵守的机制的知识来影响心力衰竭的管理。长期遵守推荐的自我管理行为是实现健康益处并减轻患者，家人和医疗保健系统负担的基础。