A Mixed Methods Evaluation of Developing COPD Exacerbations in the MARC Cohort

MARC 队列中 COPD 加重的混合方法评估

• 批准号: 10605385
• 负责人: Meredith Case
• 金额: $ 9.46万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-03-01 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10605385
• 关键词: Acute; Address; Adrenal Cortex Hormones; Agonist; Ambulatory Care; Antibiotics; Bronchodilator Agents; CCL7 gene; Caring; Chronic Obstructive Pulmonary Disease; Classification; Clinical; Data; Data Analyses; Disease; Disease Progression; Early treatment; Electronics; Emergency department visit; Enrollment; Evaluation; Guidelines; Health Care Costs; Health Services; Health Status; Healthcare Systems; Hospitalization; Incidence; Individual; Informal Social Control; Inhalators; Interview; Knowledge; Lead; Learning; Linear Regressions; Medical Care Team; Methods; Modeling; Monitor; Morbidity - disease rate; Outpatients; Participant; Patients; Process; Qualitative Research; Recovery; Research; Research Methodology; Research Personnel; Respiratory Signs and Symptoms; Risk; Risk Factors; Self Efficacy; Self Management; Structure; Symptoms; Telephone; Time; Training; United States; career; cognitive function; cohort; cost; data exchange; depressive symptoms; experience; improved outcome; medication compliance; mortality; mortality risk; negative affect; patient subsets; prevent; remote patient monitoring; response; skills; theories; tool

Project Summary/Abstract Acute exacerbations of chronic obstructive pulmonary disease (COPD) increase the morbidity and mortality of the disease and are the major drivers of its high healthcare costs. Early treatment of exacerbations with systemic corticosteroids and/or antibiotics has been shown to mitigate many of their negative effects. However, prior efforts to detect exacerbations early enough to facilitate outpatient management have demonstrated mixed results. Electronic monitoring, in which patients are remotely monitored for changes in their clinical status, is a promising approach to detect exacerbations prior to presentation to care, facilitate earlier connection to outpatient management, and prevent progression to hospitalization. Electronic inhaler monitors can be attached to short-acting beta agonist (SABA) inhalers to record each actuation and transmit that data to the healthcare team. Because patients are instructed to respond to worsening symptoms by increasing use of their SABA inhalers, electronic inhaler monitors which detect this increase in use may be a potential tool to identify clinical worsening. However, there has been little research examining the use of electronic inhaler monitors in the early stages of a COPD exacerbation. To address this knowledge gap, we will conduct a secondary data analysis of an existing cohort of >250 patients with COPD enrolled into the Medication Adherence Research in COPD Patients (MARC R01 HL 128620: PI Eakin) study. As part of the MARC study, participants are monitored with weekly electronic symptom logs, electronic inhaler monitors, and monthly phone calls collecting information on recent exacerbations for a 12-month monitoring period. In Specific Aim 1, we will leverage this data to demonstrate that SABA use increases as respiratory symptoms worsen and then examine whether these increases in SABA use are associated with increased odds of a moderate or severe exacerbation. Because prior research suggests that not all patients with worsening symptoms increase their SABA use as instructed, in Specific Aim 2 we will evaluate whether patient-level risk factors, such as low cognitive functioning, are associated with this type of poor self-management. In Specific Aim 3, we will conduct a qualitative study using semi-structured interviews guided by the framework of Self-Regulation Theory to explore participants’ thought processes around their self-management during periods of worsening symptoms. This research will therefore not only evaluate the associations among respiratory symptoms, SABA use, and exacerbations but also seeks to shed light on patient subgroups that struggle to effectively self-manage their worsening symptoms. This proposal will provide the applicant with the necessary training to develop the quantitative and qualitative skills needed to pursue an independent career as a health services researcher in COPD.

项目摘要/摘要 慢性阻塞性肺疾病（COPD）的急性加重增加了发病率和 该疾病的死亡率是其高医疗保健费用的主要驱动力。早期治疗 伴有系统性皮质类固醇和/或抗生素可减轻其许多负面影响。 但是，事先努力尽早发现加重以促进门诊管理 表现出混合的结果。电子监测，其中对患者进行远程监控以改变 它们的临床状况是一种有前途的方法，可以在介绍之前检测加重的方法，以促进 早期与门诊管理的联系，并防止进步到住院。电子吸入器 可以将监视器附加到短效Beta激动剂（SABA）的继承，以记录每种驱动并传输 该数据向医疗团队。因为指示患者应对后悔的症状 越来越多的使用SABA继承，检测到这种使用增加的电子吸入器监视器可能是 识别临床担心的潜在工具。但是，很少有研究检查 电子吸入器在COPD加重的早期阶段监视。 为了解决这一知识差距，我们将对现有队列进行辅助数据分析 > 250名COPD患者参加了COPD患者的药物依从性研究（MARC R01 HL 128620：PI EAKIN）研究。作为MARC研究的一部分，参与者通过每周电子进行监控 症状日志，电子吸入器监视器和每月电话收集有关最新信息 加重12个月的监测期。在特定目标1中，我们将利用这些数据证明 随着呼吸道症状恶化，SABA的使用增加，然后检查SABA是否增加 使用与现代或严重加重的几率有关。因为先前的研究 表明，并非所有有遗憾症状的患者按照指示增加了其SABA的使用，以特定的目的 2我们将评估患者级的危险因素（例如低认知功能）是否与此相关 自我管理不良的类型。在特定目标3中，我们将使用半结构化进行定性研究 以自我调节理论框架为指导的访谈探索参与者的思维过程 在担心症状时期的自我管理周围。因此，这项研究不仅将 评估呼吸道症状，使用和恶化之间的关联，但也试图脱落 努力自我管理的符号的患者亚组的光明。 该建议将为申请人提供必要的培训，以开发定量和 作为COPD的卫生服务研究人员，需要从事独立职业所需的定性技能。