Identifying facilitators and barriers to heart failure care in Haiti to adapt a community-based intervention

项目 T Summar Y 这项建议旨在评估心力衰竭(HF)患者和 他们的卫生系统指导循证干预，以改善中低位患者的幸福感 收入国家(LMIC)。心血管疾病(CVD)导致的死亡占海地所有死亡人数的30%；几乎是海地的4倍 死亡人数超过人类免疫缺陷病毒(HIV)。我们发表的研究表明，心力衰竭(HF)是 成人内科住院的主要原因-37%。然而，从住院到住院的关键环节 由于三分之二的心力衰竭患者没有成功地与门诊护理联系起来，门诊护理发展得不是很好， 其中，联系被定义为在出院后30天内就诊。 我的长期职业目标是发展成为一名实施科学家，并测试改进联动的策略 在低收入国家照顾心血管疾病。此应用程序的目标是首先确定贫困人口的障碍 海地农村地区心力衰竭住院患者的联系，然后适应和试点循证CHW 基于艾滋病毒模型的解决障碍的干预措施。我最重要的假设是如此复杂 可识别和可修改的生物社会和卫生系统障碍的组合如何影响海地农村地区的HF 他还指出，患者可以获得护理，适当的CHW干预措施将加强与慢性护理的联系。建议数 将与健康伙伴组织和赞米·拉桑特合作，在海地农村开展研究。 目的1：确定住院心力衰竭患者门诊护理联系的促进者和障碍。通过 从多个角度评估现有的和新的促进者的重要性以及与心衰护理联系的障碍，这 AIM将调查哪些因素影响患者返回进行后续护理的决定和能力。我将进行一次 与24-30名患者进行的一系列焦点小组讨论(按关联和非关联的患者分层)；12-15个CHW； 和8-12名医生和护士。我将确定由综合框架分类的核心概念 实施研究，并生成和完善关于促进者和联系障碍的假设。 目的2：采用CHW干预，改善对心力衰竭患者的护理。通过应用这些发现 来自目标1，使用Adapt-ITT框架，该框架已成功用于适应护理联系战略 对于HIV患者，我将修改现有的基于证据的CHW干预措施，用于患者的HIV护理 根据目标1中确定的促进者和障碍，在接受心衰治疗后出院。 目标3：试点CHW干预，评估其可行性和可接受性。我将试行改编的CHW 联动支持干预(AIM 2)，对30名心力衰竭患者样本进行干预，以改善与护理的联动。这就做 在患者、社区卫生工作者、医生、护士和卫生系统中进行定性访谈和调查 管理人员评估试点干预的可接受性、适当性、可行性和保真度 在所有利益相关者中。我将探讨二次成效成果，包括 干预组与对照组比较心力衰竭患者30例。

PROJEC T SUMMAR Y This proposal seeks to evaluate the biosocially complex interaction between heart failure (HF) patients and their health system to guide evidence-based interventions to improve wellbeing for patients in low- and middle- income countries (LMIC). Cardiovascular disease (CVD) causes 30% of all deaths in Haiti; nearly 4-times more deaths than human immunodeficiency virus (HIV). Our published work has shown that heart failure (HF) is the leading cause – 37% – of adult internal medicine hospitalizations. However, the crucial link from inpatient to outpatient care is not well developed as two-thirds of HF patients are not successfully linked to outpatient care, where linkage is defined as having a clinic visit within 30 days after discharge. My long-term career goal is to develop as an implementation scientist and test strategies to improve linkage to care for CVD in low-income countries. The objective of this application is to first identify barriers to poor linkage for patients hospitalized with HF in rural Haiti, and then to adapt and pilot an evidence-based CHW intervention to address the barriers based on models for HIV. My overarching hypotheses are that complex combinations of identifiable and modifiable biosocial and health system barriers influence how rural Haitian HF patients access care and that an adapted CHW intervention will enhance linkage to chronic care. The proposed research will be conducted in rural Haiti in collaboration with Partners In Health and Zanmi Lasante. Aim 1: Identify facilitators and barriers to outpatient care linkage for hospitalized HF patients. By assessing the salience of established and novel facilitators and barriers to HF care linkage from multiple perspectives, this aim will investigate what factors influence patients' decision and capacity to return for follow-up care. I will conduct a series of focus group discussions with 24-30 patients (stratified by those linked and not linked); 12-15 CHWs; and 8-12 doctors and nurses. I will identify central concepts categorized by the Consolidated Framework for Implementation Research, and also generate and refine hypotheses about facilitators and barriers to linkage. Aim 2: Adapt a CHW intervention to improve linkage to care for HF patients. By applying the findings from Aim 1 using the ADAPT-ITT framework, which has been successfully used to adapt care linkage strategies for HIV patients, I will modify an existing evidence-based CHW intervention used in HIV care for patients discharged after a HF admission based on the facilitators and barriers identified in Aim 1. Aim 3: Pilot the CHW intervention to assess feasibility and acceptability. I will pilot the adapted CHW linkage support intervention (Aim 2) with a sample of patients with HF (n=30) to improve linkage to care. I will use qualitative interviews and surveys among the patients, CHWs, doctors, nurses, and health system administrators to assess the acceptability, appropriateness, feasibility, and fidelity of the pilot intervention among all stakeholders. I will explore secondary effectiveness outcomes including linkage among the intervention group compared with a reference group of 30 HF patients.