Rehabilitation in Safety-Net Environments (RISE) for COPD

慢性阻塞性肺病安全网环境康复 (RISE)

• 批准号: 10346591
• 负责人: Neeta Thakur
• 金额: $ 70.45万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-02-01 至 2027-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10346591
• 关键词: Address; Adherence; Adoption; Advocate; Affect; Body Weight; Caring; Cause of Death; Chronic Obstructive Pulmonary Disease; Climacteric; Clinic; Clinical; Clinical Trials; Communities; Control Groups; County; Coupled; Disease; Disease Outcome; Economically Deprived Population; Effectiveness; Elements; Enrollment; Environment; Equipment; Evidence based intervention; Exercise; Face; Geographic Locations; Geography; Goals; Health; Health Benefit; Healthcare Systems; Hospitalization; Individual; Intervention; Interview; Leadership; Life; Link; Low income; Maintenance; Medicare; Methods; Mission; Monitor; Morbidity - disease rate; Neighborhoods; Outcome; Oxygen; Participant; Pathway interactions; Patients; Population; Primary Health Care; Process; Qualitative Methods; Quality of life; Randomized; Reach Effectiveness Adoption Implementation and Maintenance; Rehabilitation Centers; Rehabilitation therapy; Resource-limited setting; Resources; Risk; San Francisco; Self Management; Services; Site; Social Environment; Social support; Structure; Symptoms; Testing; Underinsured; Vulnerable Populations; Waiting Lists; Walking; arm; base; beneficiary; contextual factors; cost; design; effectiveness evaluation; effectiveness implementation study; effectiveness testing; evidence base; exercise training; experience; food insecurity; functional decline; functional outcomes; health care settings; health literacy; heart rate monitor; high risk; housing instability; implementation barriers; implementation evaluation; implementation intervention; improved; improved outcome; innovation; intervention delivery; intervention effect; older patient; patient engagement; patient population; patient-level barriers; peer; pilot trial; portability; post intervention; preservation; primary outcome; programs; pulmonary rehabilitation; safety net; screening; secondary outcome; social; social vulnerability; strength training; stressor; symptomatic improvement; system-level barriers; three-arm trial; treatment as usual

Project Abstract Individuals with moderate-to-severe chronic obstructive pulmonary disease (COPD) are at high risk for rapid functional decline and hospitalization. Pulmonary rehabilitation is one of the few interventions that has been shown to effectively modify the course of COPD and improve health outcomes; however, challenges in implementation and access to this high resource intervention in real-life settings have led to low-availability and engagement due to both healthcare system-level and patient-level barriers. To address barriers specific to low- resourced healthcare settings, we developed COPD Wellness with patient and clinical stakeholders. This 10- week community-based program retains key elements of pulmonary rehabilitation (exercise training, self- management, and peer social support), but is designed to be portable and feasible to deliver in diverse settings. While COPD Wellness addresses many system-level barriers, it does not directly address patient-level barriers. Lower levels of adherence are common across low-income, low health literacy communities, reflecting the burden of competing socio-environmental stressors that interfere with the ability to carry out rehabilitation activities and independently contribute to poor outcomes in COPD. We adapted the evidence-based resource support program, Health Advocates (HA), for the unmet social needs of older patients with COPD as a strategy to improve acceptance, adherence, and impact of pulmonary rehabilitation programs (Plus+). The proposed study will directly test the benefit of the COPD Wellness and Plus+ Program relative to usual care and estimate the added benefit of the HA in COPD Wellness Plus+ to COPD Wellness alone in a three-arm, randomized waitlist-controlled trial conducted in three geographically isolated urban primary care sites that provide care for some of the most socially vulnerable patient populations with COPD. In this Type 1 effectiveness- implementation hybrid design, we aim to 1) determine the effectiveness of COPD Wellness and Plus+ to improve functional and symptom outcomes; and, using a mixed-methods approach 2) to evaluate the implementation of COPD Wellness and Plus+ across study sites applying the RE-AIM and CFIR frameworks to identify additional barriers and enablers of intervention implementation and patient acceptance and adherence. COPD Wellness Plus+ was designed to specifically address barriers to rehabilitation and function within low-resourced healthcare settings. If effective, the COPD Wellness Plus+ program can offer a feasible pathway for broader implementation of low intensity pulmonary rehabilitation regionally and nationally in the U.S.

项目摘要 患有中度至重度慢性阻塞性肺疾病（COPD）的个体处于快速呼吸的高风险中。 功能下降和住院治疗。肺康复是为数不多的干预措施， 显示出有效地改变COPD的病程并改善健康结果;然而， 在现实生活环境中实施和获得这种高资源干预导致了低可用性， 由于医疗保健系统和患者层面的障碍，为解决低收入群体面临的具体障碍， 我们与患者和临床利益相关者一起开发了COPD Wellness。这10- 一周的社区计划保留了肺康复的关键要素（运动训练，自我， 管理和同伴社会支持），但其目的是便携式和可行的，以提供在不同的环境。 虽然COPD健康解决了许多系统层面的障碍，但它并不直接解决患者层面的障碍。 低收入、低健康素养社区的依从性水平较低，这反映了 相互竞争的社会环境压力源的负担，干扰了开展康复的能力 活动和独立导致COPD的不良结局。我们采用了基于证据的资源 支持计划，健康倡导者（HA），为老年COPD患者的未满足的社会需求作为一种策略 提高肺康复计划（Plus+）的接受度、依从性和影响力。 拟议的研究将直接测试COPD健康和Plus+计划相对于常规护理的益处 并在三组中估计HA在COPD Wellness Plus+中相对于单独COPD Wellness的额外获益， 在三个地理上隔离的城市初级保健中心进行的随机等待名单对照试验， 为一些在社会上最脆弱的COPD患者群体提供护理。在第1类有效性中- 实施混合设计，我们的目标是1）确定COPD Wellness和Plus+的有效性，以提高 功能和症状结果;以及，使用混合方法方法2）评估实施情况 应用RE-AIM和CFIR框架，在研究中心的COPD Wellness和Plus+中确定其他 干预实施的障碍和推动因素以及患者的接受和依从性。COPD健康 Plus+旨在专门解决资源匮乏的医疗保健中康复和功能障碍 设置.如果有效，COPD Wellness Plus+计划可以为更广泛的实施提供可行的途径 低强度肺康复在美国的地区和国家