Activating Patients to Reduce Osteoporosis (APROPOS)

激活患者减少骨质疏松症 (APROPOS)

• 批准号: 8187978
• 负责人: Kenneth G Saag
• 金额: $ 73.91万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-01 至 2016-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8187978
• 关键词: Age-Years; Area; Attention; Bone Density; Calcium; Caring; Clinical; Clinical Trials; Communication; Data; Diagnosis; Education; Ethnic Origin; Evaluation; Feedback; Fracture; Funding; Future; Guidelines; Health Personnel; Healthcare; High Risk Woman; Incentives; Individual; International; Internet; Intervention; Measures; Medicine; Methods; Movement; Observational Study; Osteoporosis; Participant; Patients; Persons; Pharmaceutical Preparations; Physicians; Public Health; Quality of Care; Questionnaires; Race; Randomized; Randomized Controlled Trials; Registries; Reporting; Research; Research Infrastructure; Research Support; Rewards; Risk; Safety; Surveys; Testing; Therapeutic; Translating; Translational Research; United States; United States Agency for Healthcare Research and Quality; Vitamin D; Woman; acronyms; arm; base; bone; cohort; comparative effectiveness; cost; effectiveness research; evidence base; experience; follow-up; health belief; health care quality; high risk; implementation research; improved; novel; novel strategies; older women; post intervention; prospective; randomized trial; research to practice; therapy design

DESCRIPTION (provided by applicant): Despite robust evidence that medications reduce secondary fracture risk among women and progressive national attention to rewarding quality of care, only about 1 in 5 older women with prior fractures receive either osteoporosis evaluation or treatment. Discovering and rigorously testing novel methods to implement evidence has become an important area of research that is featured in this proposal entitled "Activating Patients to Reduce OsteoPorosiS (APROPOS)." The Global Longitudinal Registry of Osteoporosis in Women (GLOW) is an international prospective, longitudinal, observational study of over 60,000 women 55 years of age and older, which provides the patient base for this timely study. Within GLOW there are 3,442 women in the U.S. with fractures reported on annual surveys who are not using anti-osteoporosis therapies. Among these high risk women, we will develop and test a tailored evidence implementation intervention with Specific Aims of: 1) Use formative analysis to develop a video-based direct-to-patient intervention, designed to provide personalized feedback regarding patients' risk of subsequent fractures, customized information regarding osteoporosis care, and messaging to activate them to become more proactive in improving doctor-patient communication. This novel content will use story-telling delivered via the Internet and DVDs. The content will be uniquely tailored to each person based on barriers to care, fracture risk and race/ethnicity. 2) Conduct a controlled, cluster-randomized trial of this direct-to-patient intervention among these GLOW participants (unit of randomization, prescribing physicians: unit of analysis, GLOW participants) to determine differences in post-intervention rates of osteoporosis care between two randomization arms. We hypothesize that participants (all at high risk for future fracture) randomized to the intervention arm, compared to those randomized to a control arm, will receive more osteoporosis care at 6 months post-intervention, as evidenced by higher rates of: (H1) Prescription osteoporosis therapies, (H2) Non- prescription therapy with calcium and vitamin D, and (H3) Bone mineral density (BMD) testing Exploratory analyses will examine whether the intervention leads to changes in osteoporosis-related health beliefs, greater levels of doctor-patient communication, and changes in possible concerns about osteoporosis medication safety and efficacy. This timely cluster randomized controlled trial, built upon a successful and well established cohort, provides a unique and timely opportunity to conduct this study on a national scale, in real world settings. Supported by our AHRQ funded Center for Education and Research on Therapeutics (CERTs), there is an ever-increasing movement by UAB and its collaborators to expand our substantial evidence implementation expertise towards identifying low-cost novel strategies that translate research into practice. If proven effective, this "patient activation" approach will have high applicability to evidence implementation in many other health care settings, maximizing its public health impact. PUBLIC HEALTH RELEVANCE: The majority of patients who have experienced a fracture receive neither testing nor treatment for osteoporosis. The Global Longitudinal Registry of Osteoporosis in Women (GLOW) will be used to conduct a novel evidence implementation study aimed at improving osteoporosis health care quality by activating patients to more meaningfully interact with their health care providers leading to greater rates of appropriate osteoporosis care.

描述（由申请人提供）：尽管有坚强的证据表明药物减少了妇女的继发性骨折风险，并且在国家对奖励护理质量的关注中，只有大约1个较老的骨折妇女接受骨质疏松症的评估或治疗。发现和严格测试实施证据的新方法已成为该提案中的重要研究领域，该提案题为“激活患者减少骨质疏松症（Apropos）”。妇女骨质疏松症的全球纵向注册表（Glow）是一项国际前瞻性，纵向，观察性研究，对60,000多名55岁及以上的女性超过60,000名女性，这为这项及时研究提供了患者基础。在发光中，在美国有3,442名妇女在不使用抗骨质疏松疗法的年度调查中报告骨折。在这些高风险妇女中，我们将开发和测试量身定制的证据实施干预措施，其特定目的：1）使用形成性分析来开发基于视频的直接对患者干预措施，旨在提供有关患者的风险，随后的骨折风险的个性化反馈，有关骨质疏松症护理的自定义信息，以及有关骨质疏松症护理的定制信息，并使他们更加积极地激活他们在改善医生的沟通方面变得更加积极。这种新颖的内容将使用通过互联网和DVD传达的讲故事。这些内容将根据护理障碍，骨折风险和种族/种族的障碍为每个人量身定制。 2）对这些发光参与者（随机分配，开处方医生：分析单位，发光参与者）进行这种直接对患者干预的受控，随机试验，以确定两个随机臂之间骨质疏松症护理后干预后的差异。 We hypothesize that participants (all at high risk for future fracture) randomized to the intervention arm, compared to those randomized to a control arm, will receive more osteoporosis care at 6 months post-intervention, as evidenced by higher rates of: (H1) Prescription osteoporosis therapies, (H2) Non- prescription therapy with calcium and vitamin D, and (H3) Bone mineral density (BMD) testing探索性分析将检查干预措施是否导致与骨质疏松相关的健康信念的变化，医生的沟通水平更高，以及可能关注骨质疏松症药物的安全性和有效性的可能性变化。这项及时的群集随机对照试验建立在成功且建立良好的队列的基础上，为在现实世界环境中以国家规模进行这项研究提供了一个独特而及时的机会。在我们AHRQ资助的教育和治疗研究中心（CERTS）的支持下，UAB及其合作者的运动不断增加，以扩大我们大量的证据实施专业知识，以确定将研究转化为实践的低成本新颖策略。如果被证明有效，这种“患者激活”方法将在许多其他医疗保健环境中具有很高的证据实施，从而最大程度地发挥其公共卫生影响。 公共卫生相关性：大多数经历了骨折的患者均未接受测试，也没有治疗骨质疏松症。骨质疏松症在女性中的全球纵向注册表（GLOW）将用于进行一项新的证据实施研究，旨在通过激活患者与其医疗保健提供者更有意义地与其医疗保健提供者进行更有意义的互动，从而提高骨质疏松症的医疗保健质量，从而提高适当的骨质疏松症护理的比率。