Video vs. TTG Respiratory inhaler technique Assessment and InstructioN (V-TRAIN)

视频与 TTG 呼吸吸入器技术评估和指导 (V-TRAIN)

基本信息

批准号：
8705006
负责人：
Valerie G Press
金额：
$ 15.57万
依托单位：
UNIVERSITY OF CHICAGO
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：
2013-07-22 至 2017-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8705006
关键词：
Adoption Age Asthma Award Behavior Therapy Behavioral Benchmarking Biometry Caring Cessation of life Characteristics Chronic Obstructive Airway Disease Clinical Clinical Investigator Clinical Trials Complex Data Data Collection Development Devices Diagnosis Disease Education Educational Assessment Educational Intervention Educational process of instructing Effectiveness Ensure Future Gender Goals Gold Guidelines Health education Healthcare Home environment Hospitalists Hospitalization Hospitals Inhalators Inpatients Instruction Intervention K-Series Research Career Programs Knowledge Lead Learning Module Medicine Mentored Patient-Oriented Research Career Development Award Mentors Metered Dose Inhaler Device Methods Monitor Morbidity - disease rate Observational Study Obstructive Lung Diseases Outcome Participant Patient Care Patient Education Patients Persons Pharmaceutical Preparations Positioning Attribute Powder dose form Psychological reinforcement Public Health Randomized Clinical Trials Relative (related person)Research Research Infrastructure Resources Risk Self Assessment Self Management Surveys Tablet Computer Techniques Testing Time Training Training and Education Treatment Efficacy Underserved Population United States Variant Work base behavioral clinical trial clinical practice comparative effectiveness cost cost effectiveness design disease diagnosis effectiveness research experience health care service utilization health literacy improved instructor novel older patient patient population prevent public health relevance respiratory skills willingness

项目摘要

DESCRIPTION (provided by applicant): Hospitalizations for exacerbations of asthma and COPD can likely be prevented through effective use of therapies delivered through respiratory inhaler devices. One critical rate-limiting step to effective use is correct inhaler technique. Clinical guidelines recommend assessing and teaching inhaler technique in all settings. The hospitalized patient population is a particularly salient target for evaluating and correcting inhaler technique, as inpatients are at increased risk for poor outcomes, including rehospitalizations. Hospital resources are limited, and patients' ability to retain hospital-based education is likely to be incomplete, which would require post- discharge educational reinforcement. For these reasons, developing and testing portable, effective hospital- based educational strategies are warranted. I have spent the last several years establishing the effectiveness of an in-person "Teach-to-Goal [TTG]" strategy (rounds of assessment and demonstration until mastery is attained) to instruct hospitalized patients on correct inhaler technique. While we have found that TTG is more effective than simple verbal instructions, it has limitations for implementation. First, it is resource intensive and second, it lacks portabilit for post-discharge reinforcement. Therefore, in this proposal I aim to study whether interactive video-module education (VME) that includes rounds of self-assessment and video-based demonstration, is a non-inferior approach to in-person TTG. VME directly counters TTG's limitations as it is likely less resource-intensive and is portable for post-discharge reinforcemen. Therefore I will develop VME (Aim 1a) and then will test VME vs. TTG in a randomized clinical trial, stratified by diagnosis, since there are inherent different patient and disease characteristcs among patients with asthma and COPD (Aim 1b). Finally, underserved patients may not have access to post-discharge VME. I will therefore conduct an observational study using the Hospitalist Medicine Data Collection Infrastructure, to determine the proportion of patients with access to and willingness to use post-discharge VME (Aim 2). Therefore, with this K23 career development award proposal, I will bring my research experience together with my Mentor, Dr. David Meltzer, Co-Mentor, Dr. Jerry Krishnan, and an expert advisory team in the fields of obstructive lung diseases, comparative effectiveness research, and behavioral and educational interventions to begin to fill these gaps in knowledge and clinical practice. I will use these data to design an R-01 feasibility and cost-effectiveness study to determine the real-world effectiveness of VME to help transition patients from hospital to home with sufficient educational support, and to determine if clinical outcomes improve. This award would also allow me to seek additional training in advanced biostatistics, formal training in the development and assessment of educational strategies, and training in the design and implementation of complex behavioral clinical trials. These experiences will position me to become a leader in developing, evaluating and implementing high-quality interventions to improve patient self-management of obstructive lung disease to improve clinical outcomes.

描述（由申请人提供）：通过有效使用呼吸吸入器装置提供的治疗，可以预防因哮喘和慢性阻塞性肺病恶化而住院的情况。有效使用的关键限速步骤之一是正确的吸入器技术。临床指南建议在所有环境下评估和教授吸入器技术。住院患者群体是评估和纠正吸入器技术的特别重要的目标，因为住院患者出现不良结果（包括再住院）的风险增加。医院资源有限，患者保留医院教育的能力可能不完整，这需要出院后加强教育。由于这些原因，有必要开发和测试便携式、有效的基于医院的教育策略。在过去的几年里，我一直在建立一种面对面的“目标教学 [TTG]”策略（多轮评估和演示，直到掌握）的有效性，以指导住院患者正确的吸入器技术。虽然我们发现 TTG 比简单的口头指令更有效，但它在实施方面存在局限性。首先，它是资源密集型的，其次，它缺乏出院后强化的可移植性。因此，在本提案中，我的目标是研究包括多轮自我评估和基于视频的演示的交互式视频模块教育（VME）是否是一种不劣于面对面 TTG 的方法。 VME 直接反驳了 TTG 的局限性，因为它可能资源密集度较低，并且对于退伍后的增援人员来说是可移植的。因此，我将开发 VME（目标 1a），然后在随机临床试验中测试 VME 与 TTG，按诊断分层，因为哮喘和 COPD 患者之间存在固有的不同患者和疾病特征（目标 1b）。最后，服务不足的患者可能无法获得出院后 VME。因此，我将使用住院医学数据收集基础设施进行一项观察性研究，以确定能够并愿意使用出院后 VME 的患者比例（目标 2）。因此，通过这个 K23 职业发展奖提案，我将与我的导师 David Meltzer 博士、联合导师 Jerry Krishnan 博士以及专家顾问团队一起在阻塞性肺疾病、比较有效性等领域带来我的研究经验研究、行为和教育干预措施开始填补知识和临床实践中的这些空白。我将使用这些数据设计 R-01 可行性和成本效益研究，以确定 VME 的实际有效性，帮助患者在充分的教育支持下从医院过渡到家庭，并确定临床结果是否有所改善。该奖项还将使我能够寻求高级生物统计学方面的额外培训、教育策略制定和评估方面的正式培训，以及复杂行为临床试验的设计和实施方面的培训。这些经验将使我成为开发、评估和实施高质量干预措施的领导者，以改善阻塞性肺病患者的自我管理，从而改善临床结果。