Transforming Health by Reversing Inactivity among older Veterans Everywhere! (THRIVE!)

项目目标。这一应用的具体目的是建立小说的效力 远程医疗辅助运动交付模式和最先进的第二阶段计划 远程保健有效性试验。二期的长远目标。我们工作的长远目标是 转变为任何地方的老年退伍军人提供与运动相关的医疗保健，并 通过扭转各地老年退伍军人的不活动来改变健康！ (兴旺发达！)“。我们有强有力的证据支持我们基于设施的计划，现在15岁 VHA的各个站点，并处于开发新的运动交付模式的早期阶段 使用远程医疗。这一阶段的成果欣欣向荣！规划拨款将加快下一步 通过确定远程保健提供的锻炼的有效性来进行研究的阶段。我们的设施- 基于计划已被指定为VHA最佳实践，可有效替代 机构长期护理。计划中的第二阶段试验的结果将有助于全面 经过验证的练习交付选项工具箱，适合纵向扩展以满足不断增长的需求 任何地方和任何地方老龄化的退伍军人人口。创新。我们将利用一个 使用电子诊断代码识别符合条件的退伍军人的创新筛查算法 用于安全的居家锻炼。我们能够接触到全国任何地方的退伍军人 美国将测试为家庭部署新的VHA平台的锻炼交付的创新模式- 基于护理的虚拟护理管理器(VCM)。有了VCM，我们将试验各种锻炼方法 每周锻炼一次，辅之以网站指导的锻炼或短信， 远程锻炼直接进入健身房，并根据退伍军人的喜好量身定做计划。 我们将评估患者的安全性，在家中可行的锻炼类型，疗程的频率， 体弱多病的退伍军人的人员负荷、易用性和运动适应性。冲击力。Gerofit 参与计划会产生稳健的结果，表明制度化的风险较低。 在计划注册四年后，我们的退伍军人展示了一次持续的逆转 下降的功能轨迹。我们还记录了显著改善的精神健康状况， 减少处方药的使用，相对于退伍军人来说，这是一个有利的成本效益比 公平的资源分配以及引人注目的个人变革性故事。 使用远程医疗在全国推广Gerofit促进的运动的能力很高 由于其成本证据，有可能改变对老年、行动不便的退伍军人的护理 储蓄和高质量的生活影响。第一阶段成就。(1)试行远程医疗 使用最新的退伍军人远程医疗平台VCM将锻炼计划送到家里。(2)至 评估以VCM为基础的团体交付的可行性和成功程度，并将其作为“进行/不进行”的标准 进入第二阶段试验。(3)召集和吸引不同的资深利益相关者 作为规划小组成员的小组。4)召集并参与关键的VHA计划 办公室利益相关者参与规划和设计第二阶段多站点有效性试验， 方案办公室支持传播和维持计划。下一步。完工后 在这项研究中，我们将部署和推广远程医疗方面的进展，以促进大胆 有效提供健康促进运动以满足日益增长的需求的转变 任何地方和任何地方老龄化的退伍军人

Project Goals. The specific aims of this application are to establish the efficacy of novel telehealth-assisted exercise delivery models and plan for a state-of-the-art Phase II telehealth effectiveness trial. Long-term aim of Phase II. The long-term goal of our work is to transform the delivery of exercise-related health care for older Veterans anywhere and everywhere “Transforming Health by Reversing Inactivity among older Veterans Everywhere! (THRIVE!)”. We have a strong evidence base for our facility-based programs now in place at 15 sites across the VHA, and are in the early phase of developing new models of exercise delivery using telehealth. The results of this Phase I THRIVE! planning grant will accelerate the next phase of research by determining the effectiveness of telehealth-delivered exercise. Our facility- based program is already a VHA Best Practice designated as an effective alternative to institutional long-term care. The results of the planned Phase II trial, will contribute to a fully validated toolbox of exercise delivery options suitable for scaling up to meet the growing needs of the aging Veteran population anywhere and everywhere. Innovation. We will utilize an innovative screening algorithm that uses electronic diagnostic codes to identify Veterans eligible for safe home-based exercise. Our ability to reach Veterans anywhere in the country will allow us to test innovative models of exercise delivery deploying the new VHA platform for home- based care, Virtual Care Manager (VCM). With VCM we will pilot various methods of exercise delivery; once-a-week exercise supplemented by website-guided exercise or text messaging, remote exercise directly into the gym, and tailoring program offerings to Veteran preferences. We will assess patient safety, types of exercise feasible from the home, frequency of sessions, staffing load, ease of use, and adaptations of exercise for frail Veterans. Impact. Gerofit program participation results in robust outcomes indicating reduced risk for institutionalization. Four years after program enrollment, our Veterans demonstrate a sustained reversal of a once declining functional trajectory. We also documented significantly improved mental health, reduced prescribed medication use, a favorable cost to benefit ratio relative to Veterans Equitable Resource Allocation allocations along with compelling personal transformative stories. The ability to scale Gerofit-facilitated exercise throughout the country using tele-health has high potential to transform the care of aging, mobility impaired Veterans due to its evidence of cost savings and high quality of life impact. Phase I accomplishments. (1) To pilot a tele-health delivered exercise program to the home using the newest VA telehealth platform, VCM. (2) To assess the feasibility and success of VCM for group-based delivery as a “Go/ No Go” criterion for advancement to a Phase II trial. (3) To convene and engage a diverse Veteran Stakeholder group to serve as members of the planning group. 4) To convene and engage key VHA program office stakeholders in the planning and design of a Phase II multi-site effectiveness trial with program office supported dissemination and sustainment plans. Next Steps. Upon completion of this study, we will deploy and scale advances in tele-health that will facilitate bold transformations in the effective delivery of health promoting exercise to meet the growing needs of the aging Veteran population anywhere and everywhere