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: 10806228
• 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/10806228
• 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; Diabetes Mellitus; Disease; Eating; Education; Emergency department visit; Enrollment; Future; Goals; Health; Health Benefit; Health Care Costs; Health Promotion; Health behavior; Health behavior and outcomes; 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; Patients; Pharmacists; Pharmacy facility; Physical activity; Population; Prevalence; Prevention program; Primary 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; behavior change; cardiovascular disorder risk; cardiovascular risk factor; 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 oriented; peer; peer coaching; peer support; primary care provider; primary care team; primary outcome; programs; provider behavior; 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）是退伍军人死亡率的主要原因，次优危险因素控制是CVD持续患病率的重要机制。尽管基于诊所的节目包括护士护理管理，药房支持，电话护理计划和大量质量改进工作，但CVD风险因素仍然在退伍军人中受到优先控制。鉴于退伍军人事务部内的高流行率和成本CVD，需要具有成本效益的机制来管理普遍的CVD风险因素的燃烧。资深的同伴健康教练可能就是这样的机制。但是，以前的工作通过VHA初级保健提供了该模型的有限数据。先前对非VHA人群的同伴支持的研究报告说，高血压控制和CVD风险降低的显着改善。目标：拟议的项目将测试兽医教练的有效性（资深同伴教练优化和推进心脏健康），这是一项同伴健康教练计划，旨在帮助降低退伍军人的CVD风险。这项研究的总体目标是测试家庭访问的同伴健康教练干预措施的有效性，以促进具有多个CVD风险因素的退伍军人的健康行为改变，其中包括Hybrid Type 1实施研究。为了瞄准高风险人群，我们将专注于控制高血压和至少一个其他CVD风险因素的退伍军人。方法：我们将进行一项随机对照试验，该试验将注册n = 590名退伍军人，以比较由家庭访问，电话支持和联系与适当的基于社区和诊所的适当的同伴健康教练干预措施相比，与通常的VHA初级保健相比。主要结果是从基线到1年后随访的收缩压降低。次要结果包括降低弗雷明汉心血管风险评分，个人心血管风险（烟草使用，脂质），与健康相关的生活质量和健康CAE使用。我们还将评估同伴健康教练干预对中级结果的影响，包括社会支持，患者激活，患者/提供者的沟通和健康行为（例如，药物依从性，体育锻炼，营养，饮酒和压力管理）。此外，我们对退伍军人卫生保健的影响：将同伴健康教练纳入公约初级保健团队可能会提高VA向退伍军人提供社区外展的能力。鉴于退伍军人之间可修改的风险的流行，CVD风险降低为干预提供了理想的目标。拟议的研究将增加对协议团队中同伴支持的利用的理解。如果这项研究证明了主要假设，则可以在具有其他慢性病的退伍军人中对这种基于证据的支持模型进行更广泛的测试，以改善健康结果。