Behavioral Activation Delivered via Home-based Telehealth to Improve Functioning in Cardiovascular Disease Patients Recently Discharged from Inpatient Care

通过家庭远程医疗提供行为激活，以改善最近出院的心血管疾病患者的功能

• 批准号: 10312861
• 负责人: Ronald E. Acierno
• 金额: --
• 依托单位: RALPH H JOHNSON VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-07-01 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10312861
• 关键词: Adult; Aftercare; Age; American; Anxiety; Behavioral; Cardiovascular Diseases; Caring; Centers for Disease Control and Prevention (U.S.); Clinic; Complement; Cost Savings; Crossover Design; Data; Depressed mood; Effectiveness; Elderly; Event; Evidence based treatment; Face; Home; Hospitalization; Hospitals; Infrastructure; Intervention; Measures; Mental Depression; Modeling; Moods; Morbidity - disease rate; Outcome; Patients; Phase; Preventive measure; Provider; Psychotherapy; Quality of life; Race; Randomized Clinical Trials; Recovery; Regimen; Research; Risk; Role; Secondary to; Subgroup; Testing; Time; Travel; Veterans; Visit; actigraphy; base; comparative effectiveness; compare effectiveness; comparison group; cost; emotional symptom; evidence base; experience; follow-up; functional disability; global health; hospital readmission; improved; improved functioning; innovation; inpatient service; mortality; programs; resilience; sex; standard care; standardize measure; telehealth; treatment group

Background and Significance: Following hospital discharge, risk of depression is significantly increased in cardio-vascular disease (CVD) patients. Moreover, CVD patients with depression face reduced functioning, increased morbidity and mortality, and diminished quality of life. Unfortunately, most depressed CVD patients do not receive appropriate evidence-based care for their depression, often because they are unable to, or fearful of travelling to providers for the regimen of 8-12 weekly visits of evidence-based psychotherapy such as Behavioral Activation (BA). Our group developed, evaluated and subsequently implemented in VA clinics, the first VA program to use home based telehealth to deliver BA for depression to elderly Veterans. We now propose to evaluate the ability of this evidence based treatment and delivery model (BA for depression via home- telehealth) to reduce functional impairment and improve recovery in depressed Veterans who have experienced a CVD event-related hospitalization. Research Plan and Specific Aims: 1. To compare effectiveness of Behavioral Activation for depression delivered via Home-based Telehealth- to standard post-CVD hospital discharge best-practices care in a 2x4 (treatment by time) repeated measures RCT crossover design (baseline, post-treatment, 3 & 9-month follow-up; crossover for standard treatment group at 9 months) with 132 CVD Veteran patients evincing depression in terms of central outcomes of functioning (PROMIS Functioning and Global Health scales) and emotional symptoms (PROMIS Depression and Anxiety scales) and secondary objective outcomes related to activity (actigraphy data). At the 9 month point, the comparison group will have the option of receiving the intervention (thus complementing the RCT with a crossover phase). 2. To repeat these comparisons with sex and age as independent variables. 3. To evaluate BA-HT with respect to its effects on exploratory outcomes, including re-hospitalization. Hypotheses: We predict that evidence-based psychotherapy for depression (i.e., Behavioral Activation) delivered via home based telehealth will more effectively increase social role and activity functioning, activity, mood and reduce 6-month re-hospitalization (exploratory hypothesis), compared to current best-practices post-discharge care among patients scoring at least moderately depressed on the PROMIS Depression scale one week following hospital discharge for a CVD event. Impact: If effective, this innovative treatment and delivery strategy will enhance global functioning, improve quality of life, and reduce costs to Veterans and the VA. Importantly, the proposed strategy leverages existing VA infrastructure and capabilities so that BA-HT could be immediately offered throughout VA as a preventative measure to enhance resiliency.

背景及意义： 出院后，心血管疾病患者患抑郁症的风险显着增加 （心血管疾病）患者。此外，患有抑郁症的 CVD 患者面临功能下降、发病率增加和 死亡率和生活质量下降。不幸的是，大多数抑郁的心血管疾病患者没有接受 针对他们的抑郁症采取适当的循证护理，通常是因为他们无法或害怕旅行 向提供者提供每周 8-12 次就诊的循证心理治疗方案，例如行为治疗 激活（BA）。我们的团队开发、评估并随后在 VA 诊所实施了第一个 VA 计划利用家庭远程医疗为老年退伍军人提供抑郁症学士学位。我们现在建议 评估这种基于证据的治疗和交付模式的能力（通过家庭治疗抑郁症的 BA） 远程医疗）以减少功能障碍并改善患有抑郁症的退伍军人的康复 经历过与 CVD 事件相关的住院治疗。 研究计划和具体目标： 1. 比较通过家庭提供的行为激活治疗抑郁症的有效性 远程医疗 - 以 2x4（按时间治疗）重复进行标准的 CVD 出院后最佳实践护理 衡量 RCT 交叉设计（基线、治疗后、3 个月和 9 个月随访；标准交叉 治疗组（9 个月时）有 132 名 CVD 退伍军人患者在中心结果方面表现出抑郁症 功能（PROMIS 功能和全球健康量表）和情绪症状（PROMIS 抑郁症） 和焦虑量表）以及与活动相关的次要客观结果（体动记录数据）。 9个月时 点，对照组将可以选择接受干预（从而补充 RCT 与交叉阶段）。 2. 以性别和年龄作为自变量重复这些比较。 3. 评估 BA-HT 对探索结果（包括再住院）的影响。 假设： 我们预测抑郁症的循证心理治疗（即行为激活）通过 基于家庭的远程医疗将更有效地增强社会角色和活动功能、活动、情绪和 与目前的出院后最佳实践相比，减少 6 个月的再住院次数（探索性假设） 每周对 PROMIS 抑郁量表评分至少为中度抑郁的患者进行护理 因 CVD 事件出院后。 影响： 如果有效，这种创新的治疗和提供策略将增强全球功能，改善 生活质量，并降低退伍军人和退伍军人管理局的成本。重要的是，拟议的战略利用了现有的 VA 基础设施和功能，以便可以在整个 VA 范围内立即提供 BA-HT 作为预防措施 增强弹性的措施。