Leveraging Home Health Aides to Improve Outcomes in Heart Failure

利用家庭健康助手改善心力衰竭的治疗结果

• 批准号: 10319489
• 负责人: Madeline R Sterling
• 金额: $ 19.35万
• 依托单位: WEILL MEDICAL COLL OF CORNELL UNIV
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-12-15 至 2024-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10319489
• 关键词: 911 call; Accident and Emergency department; Active Learning; Address; Adult; Advisory Committees; Affect; Ambulatory Care; Area; Award; Cardiovascular Diseases; Caring; Clinical; Clinical Medicine; Clinical Trials; Collaborations; Communication; Communities; Conduct Clinical Trials; Data; Development; Discipline of Nursing; Education; Effectiveness; Emergency department visit; Epidemiology; Evaluation; Foundations; Funding; Future; Goals; Health Care Costs; Health Policy; Health Services Research; Health Technology; Healthcare Systems; Heart failure; Home; Home Care Agencies; Home Care Services; Home Health Aides; Hospitalization; Hour; Industry; Internist; Intervention; Intervention Trial; K-Series Research Career Programs; Knowledge; Learning; Measures; Medical; Medical Care Team; Medicare; Mentored Patient-Oriented Research Career Development Award; Mentors; Mentorship; Methodology; Morbidity - disease rate; New York; Nurses; Nursing Services; Patient Care; Patient-Focused Outcomes; Patients; Persons; Physicians; Population; Positioning Attribute; Pragmatic clinical trial; Prevalence; Process; Protocols documentation; Quality of life; Randomized Controlled Trials; Research; Research Personnel; Research Training; Resources; Self Efficacy; Statistical Methods; Supervision; Surveys; Tablets; Telephone; Testing; Time; Training; Visiting Nurse; Work; acceptability and feasibility; base; beneficiary; care coordination; care delivery; care outcomes; career; caregiving; clinical epidemiology; clinical trial implementation; community partnership; cost; design; experience; feasibility testing; health care delivery; health information technology; hospital readmission; implementation science; improved; improved outcome; innovation; mortality; multidisciplinary; novel; patient home care; pilot test; post-doctoral training; preference; prevent; skills; technology validation; therapy design; therapy development; tool

Project Summary/Abstract Heart failure (HF) affects 6 million people in the US, costs over $30 billion per year, and results in 1 million hospitalizations per year. Readmission within 30 days occurs in 25% of Medicare beneficiaries admitted for HF, but previous interventions to reduce readmissions have had mixed results. An untapped potential resource for such interventions may be to engage home health aides (HHAs); after a HF hospitalization, 25% of patients are discharged home with support from HHAs. Unlike physicians or visiting nurses, HHAs are with patients on a near-daily basis, sometimes up to 24 hours per day. However, the candidate’s prior work suggests that HHAs do not receive HF-specific education and lack confidence caring for HF patients. Indeed, HHAs acknowledge that they often call 911 when they are unsure of what to do, or if they cannot reach their agency nurse for advice. While some emergency department visits may be clinically appropriate, many may be avoidable. The objective of this proposal is to design and test a novel intervention that will educate HHAs about HF and provide them with a tablet-based messaging tool that connects them with their supervising nurses. The overall hypothesis is that educated and integrated HHAs can improve outcomes in HF. Building on established community-based collaborations, the project will be conducted with the 1199SEIU-Home Care Industry Education Fund (an organization that trains 75,000 HHAs from 55 licensed home care agencies in New York, NY) and the Visiting Nurse Service of New York (the largest non-profit licensed home care agency in the U.S.). The project will include a survey of HHAs to measure the prevalence of HF training gaps and preferences for an intervention (Aim 1); a stakeholder-engaged process to design an educational and communication-based intervention (Aim 2); and a pilot randomized controlled trial to test the feasibility and acceptability of the intervention (Aim 3), laying the groundwork for a future R01 which will test its effectiveness on a larger scale. The candidate for this career development award, Madeline Sterling, MD, MPH, MS, is a general internist with expertise in clinical medicine, epidemiology, and health services research. This award will enable her to gain skills in the development and conduct of clinical trials in real-world settings designed to improve healthcare delivery and outcomes for HF patients. Dr. Sterling will be mentored by two NHBLI-funded clinician- investigators, Monika Safford, MD (primary mentor; expert in real-world clinical trials) and Lisa Kern, MD, MPH (co-mentor; expert in the evaluation of interventions designed to improve ambulatory care). Other advisors with expertise in HF, home care, technology, and implementation science will also guide her. The combination of mentorship, formal coursework, and the proposed experiential learning will position Dr. Sterling to become an independent investigator while advancing the field of home care and healthcare delivery for HF patients.

项目总结/文摘