Self-Management Training and Automated Telehealth to Improve SMI Health Outcomes

自我管理培训和自动化远程医疗可改善 SMI 健康成果

基本信息

批准号：
9323574
负责人：
Stephen J Bartels
金额：
$ 57.99万
依托单位：
DARTMOUTH COLLEGE
依托单位国家：
美国
项目类别：
财政年份：
2014
资助国家：
美国
起止时间：
2014-09-01 至 2019-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9323574
关键词：
Accident and Emergency department Action Potentials Acute Address Algorithms Behavior Behavioral Biometry Blood Pressure Caring Chronic Communities Comorbidity Data Data Collection Disease Management Educational process of instructing Effectiveness Emergency department visit General Population Glucose Grant Health Health behavior Healthcare Home Care Services Home environment Hospitalization Individual Intervention Knowledge Lipids Measures Mediator of activation protein Medical Mental Health Mental Health Services Monitor Monoclonal Antibody R24 Morality National Institute of Mental Health Nurses Outcome Persons Pilot Projects Policies Premature Mortality Primary Health Care Provider Recovery Research Infrastructure Risk SF-12 Self Management Self-Administered Services Symptoms Technology Testing Tobacco use Training base behavioral health cardiovascular risk factor cost experience follow-up healthy lifestyle high risk improved improved outcome indexing medication compliance mortality prevent primary outcome psychiatric symptom public health relevance randomized trial severe mental illness telehealth

项目摘要

DESCRIPTION (provided by applicant): Efforts to reduce early mortality in persons with serious mental illness (SMI) have largely focused on providing integrated primary care in a "health home". Yet medical care alone accounts for a disproportionately small contribution to reductions in early morality in comparison to improving self-management and health behaviors. Illness self-management training (SMT) in the general population has been shown to improve health outcomes and lower costs associated with chronic health conditions by teaching and coaching individuals on monitoring symptoms, self-administering treatments, and improving health behaviors. More recently, the use of technologies such as Automated Telehealth (AT) has been shown to improve outcomes and potentially prevent expensive emergency room and acute hospitalizations in the general population by daily prompting of self-management and remote monitoring by a nurse who can pre-emptively intervene, guided by disease management algorithms. To our knowledge, neither of these approaches has been empirically evaluated as an integrated component in a behavioral health home for persons with SMI. We propose an RCT of 300 persons with SMI and medical comorbidity to evaluate outcomes for n=100 in a Community Based Health Home alone (CBHH), compared to n=100 also receiving Self-Management Training (CBHH+SMT), and n=100 also receiving Automated Telehealth (CBHH+AT). We will test the following 3 hypotheses: Primary H1: CBHH+SMT and CBHH+AT compared to CBHH alone, will be associated with greater health self-management (measured by the Self Rated Abilities for Health Practices Scale) and (Exploratory E1) greater mental health self-management (measured by the Illness Management and Recovery Scale) at 4, 8, 12, and 24-months. Primary H2: CBHH+SMT and CBHH+AT compared to CBHH alone, will be associated with greater reduction in risk of early mortality (as measured by the Avoidable Mortality Risk Index) and (Exploratory E2) in psychiatric symptoms (BPRS) at 4, 8, 12, and 24 months. Primary H3: CBHH+SMT and CBHH+AT compared to CBHH alone, will be associated with less acute service use (emergency room visits and hospitalizations) and (Exploratory E3) less acute service use costs at 4, 8, 12, and 24-months. In order to differentiate CBHH+SMT and CBHH+AT if both are found to be effective, we will evaluate the persistence of primary outcomes from intervention endpoint (at 12 months) to the final follow-up (at 24 months) and will calculate the additional incremental costs of implementing and providing SMT and AT. We will also explore differences in subjective health (SF-12) and in individual cardiovascular risk factors (e.g., BMI, tobacco use, blood pressure, glucose, lipids), comparing CBHH+SMT, CBHH+AT, and CBHH alone. Finally, we will explore hypothesized mechanisms of action (potential mediators) for the Aim 2 primary outcome of reduced risk of early mortality (i.e., improvement in health self-management) and for the Aim 3 primary outcome of less acute service use (i.e., medication adherence and number of nurse preemptive interventions).

描述（由申请人提供）：降低患有严重精神疾病（SMI）早期死亡率的努力在很大程度上致力于在“卫生之家”中提供综合的初级保健。然而，与改善自我管理和健康行为相比，仅医疗保健造成了早期道德减少的贡献。已证明，疾病自我管理培训（SMT）通过教学和指导个人监测症状，自我管理治疗以及改善健康行为，从而改善与慢性健康状况相关的健康成本，并降低与慢性健康状况相关的成本。最近，已证明使用自动化远程医疗（AT）等技术可以改善结果，并有可能通过每天提示在疾病管理算法的指导下，可以预先进行预先介入的护士进行自我管理和远程监控，从而防止昂贵的急诊室和一般人口的急性住院。据我们所知，这两种方法都没有经过经验评估为SMI患者的行为健康之家中的综合组成部分。我们建议仅在基于社区的健康之家（CBHH）中评估300名具有SMI和医疗合并症的人的RCT，以评估N = 100的结果，而N = 100也接受了自我管理培训（CBHH+SMT），n = 100也接受自动化远程医疗（CBHH+）。我们将与单独使用CBHH相比，将测试以下3个假设：主要H1：CBHH+SMT和CBHH+，将与更大的健康自我管理（通过健康实践量表的自级能力来衡量）和（探索性E1）和（探索性E1）和更大的心理健康自我管理（通过疾病管理和恢复量表的衡量），在4、8、12和24米，衡量。原发性H2：与仅CBHH相比，CBHH+SMT和CBHH+与单独的CBHH+相比，将在4、8、12和24个月在4、8、12和24个月的精神病症状（BPRS）（探索性死亡风险指数衡量）和（探索性死亡风险指数（BPRS）（探索性E2）和（探索性E2）的降低相关。初级H3：与仅CBHH相比，CBHH+SMT和CBHH+与急性服务（急诊室就诊和住院）和（探索性E3）和（探索性E3）相比，4、8、12和24个月的急性服务使用成本较小。为了在发现两者有效的情况下区分CBHH+SMT和CBHH+，我们将评估主要结果与干预终点（12个月时）到最终随访（在24个月时）的持久性，并将计算实施和提供SMT和AT的额外增量成本。我们还将探索主观健康（SF-12）和个体心血管危险因素的差异（例如，BMI，烟草使用，血压，葡萄糖，脂质），单独比较CBHH+SMT，CBHH+AT和CBHH。最后，我们将探讨目标2的作用机制（潜在的介体），以降低早期死亡率的风险（即改善健康自我管理）和目标3的主要结果和目标3的主要结果（即，耐药性依从性和护士的预先发药的数量）。