Increasing Adherence to Pulmonary Rehabilitation after COPD-related Hospitalizations

提高慢性阻塞性肺病相关住院后肺康复的依从性

基本信息

批准号：
10241515
负责人：
Roberto Pablo Benzo
金额：
$ 56.3万
依托单位：
MAYO CLINIC ROCHESTER
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-09-20 至 2023-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10241515
关键词：
Accounting Address Adherence Award Caregivers Chronic Obstructive Airway Disease Clinical Control Groups Developed Countries Disease Dyspnea Elderly Emotional Exercise Tolerance Fatigue Feasibility Studies Feedback Health Home Hospitalization Hospitals Individual Intervention Knowledge Medical Care Costs Minority Modeling Monitor Morbidity - disease rate Outpatients Participant Patient-Focused Outcomes Patients Persons Phase Physical activity Pilot Projects Plant Roots Quality of life Randomized Randomized Clinical Trials Rehabilitation Centers Reporting System Telephone Testing Time Transportation Travel United States National Institutes of Health Woman Work arm base behavior change care outcomes clinical center comparative cost effectiveness effective intervention effectiveness testing experience feasibility testing frailty health care service utilization health related quality of life high risk hospital readmission improved low socioeconomic status mortality motivational enhancement therapy patient-level barriers prevent primary outcome programs pulmonary rehabilitation recruit rural area self-management program

项目摘要

PROJECT ABSTRACT / SUMMARY Despite proven benefits, the proportion of people with COPD who receive Pulmonary Rehabilitation (PR) is very small. The current model of a center-based PR program fails to address the needs of many patients with COPD. The most common patient barrier to attendance is travel to center-based programs, particularly for frail patients with more severe COPD who need transportation assistance. Home-based, unsupervised PR has been proposed as an alternative model to hospital-based programs and has been found to be safe and effective. In particular PR post-hospitalization has been reported as the most effective intervention to prevent a hosptal readmission; however, the reality is that many times this is not a feasible intervention as only 4% of eligible individuals are able to adhere to PR after a hospital admission (for multiple reasons). While COPD is responsible for nearly 700,000 hospitalizations annually, many of these hospitalizations, which account for a large proportion of the annual direct medical costs of COPD, are potentially preventable readmissions. In this award we plan to add Health Coaching to PR to promote a behavior change based on our previous work (R01 HL09468), that was shown to be highly effective to decrease COPD re-hospitalizations and sustainably improve QOL. We propose a simple system of Remote PR that may fill the practice gap based on our previous work (R44 HL114162; Kramer, PI; Benzo). A refined home-based PR will be tested in a well-powered phase 2 randomized clinical trial of 150 patients that will be started in the R61 period and finalized in the R33 period.

项目摘要/摘要尽管已证实有好处，但接受肺康复 (PR) 的慢性阻塞性肺病 (COPD) 患者的比例非常小。当前以中心为基础的 PR 计划模式无法满足许多患有此病的患者的需求慢性阻塞性肺病。患者就诊的最常见障碍是前往以中心为基础的项目，特别是对于体弱者需要交通援助的更严重慢性阻塞性肺病患者。以家庭为基础、无人监督的公关被提议作为基于医院的计划的替代模式，并且已被证明是安全且有效的有效的。特别是，据报道，住院后 PR 是预防疾病最有效的干预措施。再次入院；然而，现实情况是，很多时候这并不是一个可行的干预措施，因为只有 4% 的人符合资格的个人能够在入院后坚持 PR（出于多种原因）。虽然慢性阻塞性肺病是每年导致近 700,000 例住院治疗，其中许多住院治疗占慢性阻塞性肺病每年直接医疗费用的很大一部分是可以预防的再入院费用。在这个奖项中，我们计划将健康指导添加到公关中，以促进基于我们的行为改变之前的工作（R01 HL09468），被证明对于减少慢性阻塞性肺病（COPD）再住院率非常有效，持续改善生活质量。我们提出了一个简单的远程公关系统，可以填补实践空白基于我们之前的工作（R44 HL114162；Kramer，PI；Benzo）。将测试精致的家庭公关在一项有 150 名患者参与的强有力的 2 期随机临床试验中，该试验将在 R61 期间开始，在R33时期最终确定。