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

通过扭转各地老年退伍军人不活动的现象来改变健康状况！

• 批准号: 10222772
• 负责人: MIRIAM C. MOREY
• 金额: --
• 依托单位: DURHAM VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-10-01 至 2022-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10222772
• 关键词: Aging; Algorithms; Caring; Case Manager; Code; Cost Savings; Country; Diagnostic; Drug Prescriptions; Enrollment; Exercise; Frequencies; Goals; Grant; Health; Health Promotion; Healthcare; Home; Impairment; Institutionalization; Long-Term Care; Mental Health; Methods; Modeling; Outcome; Phase; Quality of life; Research; Resource Allocation; Risk; Site; Testing; Text Messaging; Veterans; Work; base; cost; design; effectiveness evaluation; effectiveness trial; evidence base; exercise program; functional decline; improved; innovation; member; military veteran; novel; patient safety; phase II trial; preference; programs; scale up; screening; success; telehealth; virtual healthcare; web site

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

项目目标。本申请的具体目的是确定新的抗肿瘤药物的功效。 远程医疗辅助运动提供模型和计划，用于最先进的第二阶段 远程医疗有效性试验。第二阶段的长期目标。我们工作的长期目标是 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， "通过扭转老年退伍军人的不活动来改变健康! （THRIVE!我们有一个强大的证据基础，我们的设施为基础的计划，现在在15 整个VHA的站点，并处于开发新的运动交付模式的早期阶段 使用远程医疗。第一阶段的结果是茁壮成长!规划补助金将加快下一个 通过确定远程保健提供的锻炼的有效性，研究阶段。我们的设施- 的计划已经是VHA最佳实践，被指定为 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 经过验证的锻炼交付选项工具箱，适合扩大规模，以满足不断增长的需求 任何地方的退伍军人老龄化创新我们将利用一个 创新的筛选算法，使用电子诊断代码来识别退伍军人资格 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， 我们将测试创新的运动交付模式，部署新的VHA平台， Virtual Care Manager（VCM）通过VCM，我们将试验各种锻炼方法 每周一次，辅以网站指导的练习或短信， 直接在健身房进行远程锻炼，并根据退伍军人的喜好定制计划。 我们将评估患者的安全性，在家可行的运动类型，会议频率， 工作人员的负担，易用性，以及对虚弱退伍军人运动的适应。冲击杰罗菲特 方案参与的结果表明，机构化风险降低。 四年后计划招生，我们的退伍军人表现出一个持续的逆转，一旦 功能轨迹下降。我们还记录了心理健康的显著改善， 减少处方药的使用，相对于退伍军人有利的成本效益比 公平的资源分配分配沿着引人注目的个人变革故事。 使用远程医疗在全国范围内扩大Gerofit促进的锻炼的能力很高， 由于成本证据，有可能改变老年、行动不便退伍军人的护理 储蓄和高生活质量的影响。第一阶段的成就。(1)远程医疗系统 使用最新的VA远程医疗平台VCM向家庭提供锻炼计划。(2)到 评估以团体为基础的暴力冲突管理的可行性和成功性，作为"进行/不进行"的标准 进入第二阶段试验(3)召集并吸引多元化的资深利益相关者 作为规划小组的成员。4)召集并参与关键的VHA计划 办公室利益相关者参与第二阶段多中心有效性试验的规划和设计， 方案办公室支持传播和维持计划。后续步骤。完成后 在这项研究中，我们将部署和扩大远程医疗的进展， 有效提供健康促进运动的转变，以满足日益增长的需求 任何地方的老年退伍军人