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) 是最常见的慢性疾病之一，也是 65 岁及以上成年人再入院的主要原因。与城市医院出院的患者相比，农村重症医院 (CAH) 出院的心力衰竭患者 30 天再入院率更高。坚持推荐的自我管理行为可以改善心力衰竭患者的健康状况并减少再入院率；然而，心力衰竭患者的依从率较低。根据我们的初步研究，在农村社区，依从性低可归因于农村心力衰竭患者获得的有关管理其慢性病的信息较少。先前的研究报告了关于旨在提高自我管理依从性的干预措施的有效性的不一致的结果。这些干预措施在农村地区的可行性尚不清楚。因此，需要创新计划来确定干预措施，以提高农村社区心力衰竭患者自我管理的依从性。这项前瞻性、两组、重复测量、随机对照试验的目的是测试为期 12 周的激活增强干预措施（患者在家激活护理 [PATCH]）对自我管理依从性和健康结果的有效性和可行性从农村医院（危重医院）出院的心力衰竭患者（再入院率）。将在 14 个月内招募 96 名心力衰竭受试者的样本。干预组和对照组都将接受常规护理。干预组还将接受两阶段的 PATCH 干预：院内出院教育课程（第一阶段）和通过电话提供的 12 周出院后教育课程（第二阶段）。制定定制策略是为了激活患者根据其基线激活水平进行自我管理行为。根据我们的初步数据，我们的中心假设是，激活水平较高的患者将具有明显更好的自我管理依从性。我们将通过以下具体目标来检验我们的假设：随着时间的推移，评估患者激活干预对自我管理依从性（目标 1）和再入院（目标 2）的影响。评估患者激活干预的机制（目标 3）。评估 PATCH 干预的可行性（目标 4）。 PATCH干预的创新之处在于：1）它将患者激活理论转化为干预策略，以改善弱势人群（居住在农村社区的农村心力衰竭患者）的自我管理，2）它测试了患者激活对自我管理的机制坚持； 3）利用农村护理理论指导农村社区制定可持续的干预计划； 4）评估通过单次尿检收集的生物标志物作为心衰患者自我管理依从性的指标。这项研究将通过增加有关提高农村社区心力衰竭患者自我管理依从性的机制的知识来影响心力衰竭的管理。长期坚持推荐的自我管理行为是实现健康益处并减轻患者及其家人和医疗保健系统负担的基础。