The Home Environment and Re-hospitalization in COPD study (HEAR COPD)

慢性阻塞性肺病研究中的家庭环境和再住院 (HEAR COPD)

基本信息

批准号：
10630924
负责人：
Nirupama Putcha
金额：
$ 60.57万
依托单位：
JOHNS HOPKINS UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-09-15 至 2025-05-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10630924
关键词：
Accident and Emergency department Acute Air Air Pollution Allergens Allergic Asthma Automobile Driving Back Bacterial Infections Baltimore Biometry Cause of Death Characteristics Chronic Obstructive Pulmonary Disease Clinical Clinical Research Cohort Studies Collaborations Collection Complex Cost of Illness Data Data Analytics Direct Costs Disease Disease Outcome Dust Emergency department visit Environment Environmental Health Epidemiology Exposure to Facilities and Administrative Costs Future Goals Hand Health Expenditures Home Home environment Hospitalization Hospitals Hypersensitivity Immunology Individual Indoor Air Pollution Indoor environment Infrastructure Lung diseases Measures Mentored Patient-Oriented Research Career Development Award Methods Modification Morbidity - disease rate Nitrogen Dioxide Observational Study Outcome Outpatients Particulate Matter Patients Population Prevalence Productivity Research Research Infrastructure Research Personnel Risk Risk Factors Risk Reduction Smoke Societies Testing United States Virus Diseases Visit Vulnerable Populations Work adverse outcome clinical phenotype coarse particles cohort cost data management economic cost environmental intervention experience fine particles former smoker health care service utilization high risk high risk population hospital readmission improved outcome indexing indoor allergen indoor pollutant interest lung health modifiable risk multimodality pollutant primary outcome recruit societal costs therapy design ultrafine particle

项目摘要

COPD is a costly disease with a large burden of costs driven by healthcare utilization during acute exacerbations of illness, particularly those driven by emergency room and hospital visits. Additionally, a large proportion of individuals with COPD recently hospitalized for acute exacerbations are re-hospitalized both within one month but also within a year. These re-hospitalizations place a tremendous burden of cost on society not just due to direct costs but also indirect costs and lost productivity. A majority of individuals with COPD are discharged home, back to the very environment that was likely contributing to their disease morbidity. Indoor air pollution and allergen sensitization with exposure are important components of the home environment that likely contribute to exacerbation risk as has been shown in mostly stable, outpatient populations of former smokers with COPD. However, little is known about these factors in the highly vulnerable population of individuals recently hospitalized with COPD exacerbations, who have different characteristics and competing risks than stable outpatient populations. Accordingly, we propose a single center observational study of individuals with COPD, to be recruited during hospitalization for COPD exacerbation. We hypothesize that in-home air pollution, including ultrafine and fine particulate matter and nitrogen dioxide (Specific Aim 1) as well as allergen sensitization with exposure (Specific Aim 2) will be associated with heightened risk for the primary outcome of interest, re-hospitalization for COPD exacerbation. The home environment will be assessed within 1 week of discharge from the hospital, and again at 3, 6, and 9 months post index hospitalization in addition to clinical measures. Outcomes will be assessed up to one year post index hospitalization. This study will provide much needed information about the contribution of indoor air pollution and allergen sensitization with exposure to re- hospitalizations in the high-risk population of individuals with COPD recently hospitalized for exacerbation. We believe that this study can provide valuable information which can ultimately be utilized to design interventions to modify the home environment post-hospital discharge with the goal to improve outcomes including re- hospitalization risk in COPD. 1

COPD是一种昂贵的疾病，在急性加重过程中由医疗保健利用驱动的费用很大疾病，尤其是那些受急诊室和医院探访驱动的疾病。另外，很大一部分最近因急性加重而住院的COPD的人在一个月内重新住院但也要在一年之内。这些重新建筑物给社会带来了巨大的成本负担，不仅是由于直接成本，但也间接成本和生产力失去。大多数患有COPD的人已出院家，回到可能导致其疾病发病率的环境。室内空气污染与暴露的过敏原敏化是家庭环境的重要组成部分如前大多数稳定的门诊患者人群所表明的，有助于加剧风险与COPD。但是，最近在高度脆弱的个体中，这些因素知之甚少患有COPD加重的住院，他们的特征和竞争风险与稳定不同门诊群体。因此，我们提出了一个COPD个体的单一中心观察研究，在住院期间招募COPD加重。我们假设该内空气污染，包括超铁和细颗粒物和二氧化氮（特定目标1）以及过敏原通过暴露敏化（特定目标2）将与主要结果的主要风险相关兴趣，重新院长加剧。家庭环境将在从医院出院，除临床外，指数后3、6和9个月再次出院措施。索引住院后最多评估结果。这项研究将提供很多需要有关室内空气污染和过敏原敏化的贡献的信息，并暴露于重新 COPD患者高危人群的住院最近因加剧而住院。我们相信这项研究可以提供有价值的信息，这些信息最终可用于设计干预措施为了修改家庭环境后出院后的目标，以改善结果 COPD的住院风险。 1