Implementing a digitally-enabled community health worker intervention for patients with heart failure

项目总结/摘要 在美国，心力衰竭（HF）30天再入院产生了超过三分之一的HF医疗保健费用， 美国30天再入院HF再入院的驱动因素包括与以下因素相关的复杂性增加： 临床社会和行为因素尽管采取了许多干预措施，但再入院率仍然很高， 其中四分之一可以通过多学科方法来预防， 与临床护理团队沟通，同时解决HF护理的社会和行为障碍。社区 卫生工作者（CHW）是医疗队的成员，负责处理社会、行为和基本临床因素 影响健康结果，同时促进患者与护理团队的联系和沟通。CHW 护理是显示可减少慢性病患者再入院的少数干预措施之一。然而，CHW 护理依赖于密集的1：1患者护理模式，该模式不利用限制效率的技术， 可伸缩性在CHW护理中，对开发基于技术的干预措施的关注有限， 减少HF 30天再入院。一种基于HF移动的电话应用的数字平台， 智能驱动的生物特征数据，以最大限度地减少误报，促进早期识别真正的衰退， 2016年开发了鼓励与提供者沟通的方法，以减少HF 30天再入院。 数字平台的初步临床试验数据很有希望。一种为患有 最近成立了HF和照顾他们的CHW。目前的提案将评估可接受性， 数字化CHW干预减少HF 30天的可行性和初步有效性 再入院目标1：识别行为（例如，饮食，活动）和社会（例如，社会经济地位 支持、生活状况）影响与数字化CHW干预相关的HF结局的因素， 对30名HF患者和20名CHW进行半结构化访谈。目标2：测试数字系统的可用性- 在一项开放性初步试验中，在10名HF患者中启用CHW干预（重点是CHW工作流程整合）。 目标3：评估实施数字化的可接受性、可行性和初步有效性 在一项试点RCT（n=50）中，将CHW干预与CHW护理进行比较，以减少HF 30天再入院率。的 候选人的总体职业目标是：识别HF/心血管临床的社会和行为驱动因素 结果;发展定性方法，行为科学和RCT的专业知识;最终，发展 改善HF/心血管疾病和其他NHLBI疾病的护理和降低成本的干预措施 的generalists。该培训计划包括强有力的指导，正式的课程和科学会议， 行为和社会科学的凝聚力培训，定性研究和RCT的进行。这 该提案调查了一种潜在的变革性干预措施，通过以下方式解决文献中的重要空白： 评估数字化CHW干预的可接受性、可行性和初步有效性， 减少30天的再入院率并提高患者参与度。

Project Summary/Abstract Heart failure (HF) 30-day readmissions generate over a third of HF healthcare costs in the US and are the leading cause of US 30-day readmissions. Drivers of HF readmissions include increasing complexity associated with clinical, social, and behavioral factors. Despite numerous interventions, readmission rates remain elevated and a quarter of these could be prevented by a multidisciplinary approach promoting better connections to and communication with clinical care teams while addressing social and behavioral barriers to HF care. Community health workers (CHWs) are members of medical teams who address social, behavioral, and basic clinical factors influencing health outcomes while fostering patient connections to and communication with care teams. CHW care is one of a few interventions shown to reduce readmissions in patients with chronic disease. However, CHW care relies on intensive 1:1 patient care models that do not leverage technology which limits efficiency and scalability. There has been limited attention on developing technology-based interventions in CHW care to reduce HF 30-day readmissions. A HF mobile phone application-based digital platform that utilizes artificial intelligence driven biometric data to minimize false alarms, promotes early identification of true decline, and encourages communication with providers was developed in 2016 to reduce HF 30-day readmissions. Preliminary clinical trial data for the digital platform has been promising. A prototype designed for patients with HF and the CHWs caring for them has recently been created. The current proposal will assess the acceptability, feasibility, and preliminary effectiveness of a digitally-enabled CHW intervention to reduce HF 30-day readmissions. Aim 1: Identify behavioral (e.g., diet, activity) and social (e.g., socioeconomic status, social supports, living situation) factors that influence HF outcomes relevant to a digitally-enabled CHW intervention by performing semi-structured interviews with 30 patients with HF and 20 CHWs. Aim 2: Test usability of a digitally- enabled CHW intervention (focused on CHW workflow integration) in 10 patients with HF in an open pilot trial. Aim 3: Assess the acceptability, feasibility, and preliminary effectiveness of implementing a digitally-enabled CHW intervention compared to CHW care to reduce HF 30-day readmissions within a pilot RCT (n=50). The candidate’s overall career goals are: to identify social and behavioral drivers of HF/cardiovascular clinical outcomes; to develop expertise in qualitative methods, behavioral science, and RCTs; and ultimately, to develop interventions that improve care and reduce costs in HF/cardiovascular disease and other NHLBI diseases seen by generalists. This training plan includes strong mentorship, formal coursework, and scientific meetings with cohesive training in behavioral and social sciences, qualitative research, and the conduction of RCTs. This proposal investigates a potentially transformative intervention that addresses important gaps in the literature by assessing the acceptability, feasibility, and preliminary effectiveness of a digitally-enabled CHW intervention in reducing 30-day readmissions and improving patient engagement.