Symptom Care at Home-Heart Failure: Developing and piloting a symptom monitoring and self-management coaching system for patients with heart failure

家庭症状护理-心力衰竭：为心力衰竭患者开发和试点症状监测和自我管理辅导系统

• 批准号: 10400005
• 负责人: Youjeong Kang
• 金额: $ 14.53万
• 依托单位: UNIVERSITY OF UTAH
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-04-15 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10400005
• 关键词: Algorithms; Area; Attention; Behavior; Caring; Chemotherapy-Oncologic Procedure; Clinical Trials; Clinical Trials Design; Collaborations; Computer Interface; Data; Development; Disease; Emergency department visit; Ensure; Feedback; Future; Goals; Guidelines; Health; Health Care Visit; Health system; Heart failure; Home; Home Care Services; Hospitals; Inpatients; Instruction; International; Intervention; Leadership; Malignant Neoplasms; Measures; Medical; Mentored Patient-Oriented Research Career Development Award; Mentors; Monitor; Oncology; Outcome; Patient Outcomes Assessments; Patient-Focused Outcomes; Patients; Phase; Pilot Projects; Positioning Attribute; Quality of life; Randomized Controlled Trials; Reporting; Research; Research Personnel; Review Literature; Self Management; Severities; Statistical Data Interpretation; Symptoms; System; Technology; Telephone; Testing; Time; Treatment Failure; Universities; Utah; Voice; Weight; acceptability and feasibility; acute care; base; care systems; career; career development; clinical practice; evidence base; experience; health care settings; hospital readmission; improved; innovation; member; prevent; recruit; response; skills; successful intervention; symptom management; symptom self management; telemonitoring; treatment as usual

This is a K23 award application for Dr. Youjeong Kang, an experienced clinician in inpatient and home health care settings, to independently develop and test innovative interventions for heart failure (HF) management that are effective and scalable, as well as improve care for HF patients. The K23 will provide her the support necessary to acquire critical skills in four key career development areas: 1) enhance expertise in HF symptoms and self-management based on patient-reported outcomes (PRO) data; 2) develop expertise in clinical trial design and implementation for the home-based symptom management intervention testing; 3) acquire further professional development and leadership skills; and 4) obtain skills in developing and adapting technology-aided interventions (i.e., app-based platform). To achieve her goals, Dr. Kang has assembled an interdisciplinary mentoring team comprised of Drs. Kathi Mooney (Primary Mentor), an internationally recognized expert in oncology symptom management using telephone-enabled interventions; Josef Stehlik (Co-Mentor), an experienced cardiologist with an independent research career focused on HF treatments; and Gary Donaldson (Advisor), an expert in multivariate longitudinal statistical analyses. Keeping HF patients at home with a low symptom burden after hospital discharge is challenging. Evidence shows that delay in HF symptom recognition and poor self-management are associated with unplanned emergency department visits and rehospitalizations. Clinical trials aimed at preventing rehospitalization using telemonitoring have shown limited utility suggesting that monitoring physical changes alone may not be sufficient to maintain stability of HF patients at home. A recent cancer study has demonstrated that patients receiving cancer chemotherapy achieved a 40% reduction in symptoms using Symptom Care at Home (SCH), a computer-interface telephonic interactive voice response system pairing patient-reported symptoms with automated real-time, self-management coaching. While a few HF studies have used interventions that monitored symptoms, no studies have tested a system that monitors and provides real-time, self-management coaching tailored to specific PRO. Dr. Kang’s objective is to pilot an adaption of the SCH system to HF resulting in preliminary data to support a fully-powered randomized control trial to test an adapted SCH-HF system that could be widely disseminated. She proposes the following Specific Aims over two-parts: Aim 1] Tailor the real-time self-management coaching system to integrate HF symptom monitoring and self- management coaching into the SCH-HF system; and Aim 2] Conduct a pilot randomized controlled trial (RCT) to assess the feasibility, acceptability, and preliminary efficacy of the SCH-HF system. The proposed research is significant because it expands our understanding into HF symptom monitoring and management using PRO in the home setting. The proposal is innovative because it integrates HF clinician and patient perspectives to develop a daily home monitoring and real-time self-management coaching system.

这是针对住院和家庭领域经验丰富的临床医生 Youjeong Kang 医生的 K23 奖励申请 医疗保健机构，独立开发和测试心力衰竭（HF）的创新干预措施 有效且可扩展的管理，以及改善心力衰竭患者的护理。 K23将为她提供 获得四个关键职业发展领域关键技能所需的支持：1）增强以下方面的专业知识： 基于患者报告结果 (PRO) 数据的心力衰竭症状和自我管理； 2）发展专业知识 家庭症状管理干预测试的临床试验设计和实施； 3） 获得进一步的专业发展和领导技能； 4）获得发展和适应的技能 技术辅助干预措施（即基于应用程序的平台）。为了实现她的目标，康博士组建了一个 由博士组成的跨学科指导团队。 Kathi Mooney（首席导师），国际 使用电话干预措施进行肿瘤学症状管理的公认专家；约瑟夫·斯特里克 （联合导师），一位经验丰富的心脏病专家，专注于心力衰竭治疗的独立研究生涯；和 加里·唐纳森（顾问），多元纵向统计分析专家。 出院后让心力衰竭患者在家中保持较低的症状负担是一项挑战。证据 研究表明，心力衰竭症状识别的延迟和自我管理不良与计划外的事件有关 急诊科就诊和再住院。旨在预防再住院的临床试验 远程监测的效用有限，这表明仅监测身体变化可能并不可行 足以维持心衰患者在家中的稳定性。最近的一项癌症研究表明，患者 使用家庭症状护理 (SCH)，接受癌症化疗的症状减轻了 40%， 计算机接口电话交互式语音应答系统将患者报告的症状与 自动化的实时自我管理辅导。虽然一些心力衰竭研究使用的干预措施 监测症状，没有研究测试过监测和提供实时自我管理的系统 针对特定专业人士量身定制的辅导。 Kang 博士的目标是试点 SCH 系统适应 HF 产生初步数据来支持全功率随机对照试验，以测试改编的 SCH-HF 可以广泛传播的系统。她提出了以下两部分的具体目标：目标 1] 量身定制实时自我管理辅导系统，将心力衰竭症状监测与自我管理融为一体 SCH-HF 系统的管理辅导；目标 2] 进行试点随机对照试验 (RCT) 评估 SCH-HF 系统的可行性、可接受性和初步功效。拟议的研究 意义重大，因为它扩展了我们对使用 PRO 进行心力衰竭症状监测和管理的理解 在家庭环境中。该提案具有创新性，因为它将心力衰竭临床医生和患者的观点结合起来 开发日常家庭监控和实时自我管理辅导系统。