A mixed methods study to identify and refine implementation strategies to increase use of cardiac rehabilitation for patients with heart failure

一项混合方法研究，旨在确定和完善实施策略，以增加心力衰竭患者心脏康复的使用

• 批准号: 10645098
• 负责人: Tara C Lagu
• 金额: $ 41.61万
• 依托单位: NORTHWESTERN UNIVERSITY AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-05-25 至 2025-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10645098
• 关键词: Accounting; Acute Coronary Event; Adult; Advocate; Aerobic; Affect; American; American Heart Association; Body Weight decreased; Cardiac; Cardiac rehabilitation; Cardiology; Cardiovascular system; Chronic Disease; Clinical; Clinical Practice Guideline; Clinical Research; Collaborations; Communities; Consolidated Framework for Implementation Research; Coronary Artery Bypass; Counseling; Data; Development; Diagnosis; Diet; Disease; EFRAC; Ecosystem; Education; Eligibility Determination; Event; Evidence based intervention; Exercise; Exercise Tolerance; Feedback; Future; Goals; Health; Health system; Heart failure; Hospital Referrals; Hospitalization; Hospitals; Impairment; Influentials; Inpatients; Intervention; Interview; Investigation; Lifestyle Therapy; Maps; Medicare; Medicare claim; Methods; National Heart, Lung, and Blood Institute; Outpatients; Patient Admission; Patient Education; Patient Participation Rates; Patient Self-Report; Patient advocacy; Patient-Focused Outcomes; Patients; Play; Policies; Policy Maker; Population; Practice Guidelines; Prevention program; Qualitative Methods; Quality of life; Recommendation; Records; Reporting; Research; Risk; Risk Factors; Risk Reduction; Role; Secondary Prevention; Self Care; Standardization; Statistical Data Interpretation; Structure; System; Translational Research; United States Centers for Medicare and Medicaid Services; Variant; acute coronary syndrome; advocacy organizations; beneficiary; college; comorbidity; contextual factors; deviant; exercise training; functional status; future implementation; hospital readmission; implementation research; implementation strategy; implementation trial; improved; improved outcome; mortality; multidisciplinary; preservation; programs; pulmonary rehabilitation; randomized, controlled study; readmission rates; recruit; smoking cessation; stress reduction; symptomatic improvement

PROJECT SUMMARY More than 6.5 million American adults have HF, which results in approximately 1 million hospital admissions per year in patients 65 year and older. Hospitalized patients with HF have a 30-day mortality rate of approximately 10%. Cardiac rehabilitation (CR), a multidisciplinary structured secondary prevention program that applies effective lifestyle therapies (diet, exercise, stress reduction, smoking cessation, weight loss, etc.) to reduce the risk of secondary cardiac events and improve functional status, has demonstrated a modest reduction in all-cause mortality in patients with HF and reduced ejection fraction (HFrEF). Randomized controlled studies of patients with HFrEF or HF with preserved ejection fraction have reported that CR improves symptoms, increases aerobic capacity, endurance, improves self-reported quality of life, and reduces rehospitalization. The American Heart Association and the American College of Cardiology recommend exercise training for patients with HF, and, in 2014, the Centers for Medicare and Medicaid Services began to cover CR for patients with HFrEF. However, national data suggest that only 2-10% of patients with HF attend CR after a hospitalization and our preliminary data suggest that little improvement has occurred since 2014. Our long-term goal is to identify effective delivery-system interventions that improve the health and outcomes of patients with HF. The objective of this proposal is to identify implementation strategies that increase participation in CR among patients with HF. Then with a group of clinicians, patient advocacy organizations, CR leaders, policymakers, and payers, we will prioritize strategies that are the most acceptable, feasible, and responsive to the needs of the community. In Aim 1, we will analyze Medicare claims among recently hospitalized HF patients to identify hospital-referral regions (HRRs) that are most and least successful in recruiting recently hospitalized patients with HF to CR. Beginning with these programs, we will use the Consolidated Framework for Implementation Research (CFIR) to guide qualitative interviews of clinicians with these HRRs, identifying facilitators and barriers to CR participation. We will present our findings to a panel of stakeholders who will prioritize strategies. We will then pilot these strategies in a subset of CR practices in order to refine the final set of recommendations that will inform practice (e.g., outpatient and inpatient clinicians, CR programs, patients), policy (e.g., clinical practice guidelines and reimbursement strategies), and future research (e.g., implementation trials). These activities are highly responsive to the STIMULATE RFA because they are timely, engage a range of stakeholders, and examine implementation of an underutilized evidence-based intervention. They are also consistent with National Heart, Lung, and Blood Institute's Strategic Goals and Objectives, specifically objective 6, which aims to “optimize translational, clinical, and implementation research to improve health and reduce disease.”

项目摘要 超过650万的美国成年人患有HF，导致大约100万个医院入院 每年65岁及以上的患者。 HF住院的患者的死亡率为30天 约10％。心脏康复（CR），一个多学科结构化二级预防计划 这采用有效的生活方式疗法（饮食，运动，减轻压力，戒烟，减肥等） 为了降低继发性心脏事件的风险并提高功能状况，已经表现出适度的 HF患者和射血分数降低（HFREF）的全因死亡率降低。随机 HFREF或HF患者的对照研究保留了射血分数 改善症状，增加有氧能力，耐力，改善自我报告的生活质量并减少 重新建立。美国心脏协会和美国心脏病学院建议 HF患者的运动训练，2014年，Medicare和Medicaid服务中心开始 覆盖HFREF患者的CR。但是，国家数据表明只有2-10％的HF患者参加 住院后的CR和我们的初步数据表明，自2014年以来几乎没有改善。 我们的长期目标是确定有效的交付系统干预措施，以改善健康和结果 HF患者该提案的目的是确定增加的实施策略 在HF患者中参与CR。然后与一群临床医生，患者宣传组织， CR领导人，政策制定者和付款人，我们将优先考虑最可接受，可行的策略 响应社区的需求。在AIM 1中，我们将在最近分析Medicare主张 住院的HF患者，以识别最成功和最不成功的医院转诊区域（HRR） 招募最近住院的HF患者到CR。从这些程序开始，我们将使用 合并实施研究框架（CFIR）指导临床医生的定性访谈 这些HRR，确定了CR参与的促进者和障碍。我们将提出我们的发现 将优先考虑策略的利益相关者。然后，我们将在CR实践的一部分中试用这些策略 为了完善最终的建议，这些建议将为实践提供信息（例如，门诊和住院医师 临床医生，CR计划，患者），政策（例如临床实践指南和报销策略）和 未来的研究（例如，实施试验）。这些活动对刺激RFA的反应很高 因为他们是及时的，请参与一系列利益相关者，并进行未充分利用的审查实施 基于证据的干预。他们也与国家心脏，肺和血液研究所的 战略目标和目标，特别是目标6，旨在“优化翻译，临床和 实施研究以改善健康并减少疾病。”