Telehealth-delivered peer support to improve quality of life among Veterans with multimorbidity

远程医疗提供同伴支持，以改善患有多种疾病的退伍军人的生活质量

• 批准号: 10420988
• 负责人: Kristen E Gray
• 金额: --
• 依托单位: VA PUGET SOUND HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-10-01 至 2026-09-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10420988
• 关键词: Address; Adverse effects; Behavioral; Caring; Chronic; Chronic Disease; Clinic Visits; Clinical; Communities; Community Outreach; Complex; Data; Disease; Education; Electronic Health Record; Emergency Care; Emergency department visit; Enrollment; Evaluation; Face; Future; Goals; Guidelines; Health; Health Care Costs; Health Services Accessibility; Health behavior; High Prevalence; Hybrids; Impaired health; Individual; Inpatients; Intervention; Intervention Trial; Life Style; Link; Measures; Mediating; Medical Care Team; Mental Health; Modeling; Outcome; Patient Self-Report; Patient-Centered Care; Patient-Focused Outcomes; Patients; Personal Satisfaction; Persons; Planning Techniques; Polypharmacy; Population; Practice Management; Primary Health Care; Problem Solving; Provider; Qualitative Methods; Quality of life; Randomized; Reach Effectiveness Adoption Implementation and Maintenance; Research; Resources; SF-12; Self Efficacy; Self Management; Services; Social support; Standardization; Technology; Testing; Text Messaging; Time; Training; Translating; Treatment Protocols; United States Department of Veterans Affairs; Veterans; Veterans Health Administration; Visit; Work; base; body system; care delivery; care outcomes; clinical care; cost; disability; effectiveness evaluation; effectiveness implementation study; effectiveness-implementation RCT; electronic data; emotional symptom; experience; frailty; future implementation; health care service utilization; health difference; health related quality of life; high risk; hybrid type 1 trial; implementation facilitators; implementation intervention; improved; in-home care; innovation; intervention cost; intervention participants; meetings; mortality; multiple chronic conditions; patient oriented; patient-clinician communication; patient-level barriers; peer; peer support; physical conditioning; physical symptom; primary outcome; programs; psychological distress; psychosocial; remote delivery; rural area; screening; secondary outcome; shared decision making; success; telehealth; telehealthcare; treatment as usual; video visit; virtual; virtual healthcare

Background: More than 50% of Department of Veterans Affairs (VA) patients have multimorbidity: the co- occurrence of >2 chronic conditions. Multimorbidity impairs health-related quality of life (HRQoL); leads to psychologic distress, disability, and mortality; and contributes to high health care utilization and costs. Most chronic conditions require patients to engage in disease self-management, including adhering to treatments, making lifestyle changes, and working with their health care team. Patients with multimorbidity face many barriers to self-management and to attending in-person clinic visits. Given the limited time and competing demands of primary care visits, patients with multimorbidity need additional support for self-management. Peer support – assistance provided by non-professionals who are similar to the populations they serve – delivered via telehealth is suited to address these needs. We developed a virtual, Veteran-led peer health coaching intervention, VetASSiST (Veterans Activating Social Support for Self-management and Treatment engagement), to help patients with multimorbidity overcome barriers to self-management and improve HRQoL. Significance: VetASSiST is timely and efficient and aligns with the HSR&D priority that improving care should support coordination and integration of care for the majority of Veterans who have multiple conditions rather than building new single disease interventions. The proposal also aligns with other HSR&D priorities of Primary Care Practice and Management of Complex Chronic Diseases and Virtual Care/Telehealth. Innovation and Impact: Prior peer support trials address individual chronic conditions or mental health. VetASSiST will be one of the first trials of an intervention to support Veterans with multimorbidity. It will also be one of the first to leverage telehealth to remotely deliver peer support, which has the potential to increase access to care. If effective, the intervention could be broadly implemented to improve patient outcomes. Specific Aims: 1) Test the effect of VetASSiST, compared to usual care, on the primary outcome of baseline to 12-month change in physical HRQoL, and secondary outcomes of mental HRQoL and health care utilization; 2a) Describe differences between VetASSiST and usual care on baseline to 12-month changes in intermediate outcomes reflecting the functions of peer support and intervention targets: self-efficacy, patient activation, health behaviors, social support, perceived access to care, patient-provider communication, and shared decision-making; 2b) Examine whether intermediate outcomes mediate intervention-associated differences in HRQoL; 3) Evaluate feasibility of translating VetASSiST into practice, including evaluation of per patient intervention costs and barriers and facilitators to implementation. Methodology: We plan a hybrid type 1 implementation-effectiveness randomized controlled trial of 320 Veterans with complex multimorbidity, defined as >3 chronic conditions in >3 body systems. Patients must also have >1 of: 1) physical and mental health conditions; 2) frailty; 3) frequent emergency care; 4) polypharmacy; or 5) high treatment burden. We will identify eligible patients using data from the electronic health record, confirmed with self-reported information at screening, and will randomize enrolled patients 1:1 to VetASSiST or usual care control. The primary outcome is change in physical HRQoL from baseline to 12-months, measured with the SF-12. Secondary outcomes include change in mental HRQoL (SF-12) and health care utilization. Guided by the RE-AIM framework, we will use quantitative and qualitative methods to assess barriers and facilitators to implementation among key stakeholder groups. These data will inform future implementation. Next Steps/Implementation: This hybrid type 1 trial will provide data needed to prepare for broader VA implementation if the intervention is effective. Implementation activities will be coordinated with existing local and national operational partners. If the intervention is not effective, Aims 2 and 3 will elucidate how Veterans with multimorbidity could be better supported in the future.

背景：超过50％的退伍军人事务部（VA）患者具有多种病态： 发生> 2种慢性条件。多发病损害与健康相关的生活质量（HRQOL）；导致 心理困扰，残疾和死亡率；并有助于高度医疗保健利用和成本。最多 慢性病要求患者从事疾病自我管理，包括遵守治疗， 改变生活方式，并与他们的医疗团队合作。多种病毒的患者面临许多 自我管理和参加面对面诊所的障碍。考虑到有限的时间和竞争 对初级保健访问的需求，多种病态的患者需要额外的支持以进行自我管理。同行 支持 - 与他们所服务人群相似的非营利人提供的帮助 - 交付 通过远程医疗可满足这些需求。我们开发了一项虚拟的，由资深的同伴健康教练 干预措施，源自审查员（退伍军人激活社会支持和治疗的社会支持 参与），以帮助多发病患者克服自我管理的障碍并改善HRQOL。 意义：验证师及时有效，并且与HSR＆D的优先级相吻合，即改善护理应 支持多种条件的大多数退伍军人的协调和整合护理 而不是建立新的单疾病干预措施。该提案还与主要的其他HSR＆D一致 复杂的慢性疾病和虚拟护理/远程医疗的护理实践和管理。 创新和影响：事先同伴支持试验解决了个体的慢性病或心理健康。 Vetassist将是支持具有多种多发性退伍军人的干预措施的最早试验之一。也将是 最早利用远程医疗来远程提供同伴支持的人之一，这有可能增加 获得护理。如果有效，则可以广泛实施干预措施以改善患者预后。 具体目的：1）与通常的护理相比，测试验证者对基线的主要结果的影响 身体HRQOL的12个月变化以及精神HRQOL和医疗保健利用的次要结果； 2a）描述源头和平时护理之间在基线上的差异到中间的12个月变化 反映同伴支持和干预目标功能的结果：自我效能感，患者激活， 健康行为，社会支持，可感知的获得护理，患者提供的沟通和共享 决策; 2b）检查中间结果是否介导与干预相关的差异 hrqol; 3）评估将验证者转化为实践的可行性，包括评估每个患者 干预成本，障碍以及实施的促进者。 方法论：我们计划了320的混合型实施效应随机对照试验 具有复杂多发经能的退伍军人，定义为> 3个身体系统中> 3个慢性条件。患者也必须 具有> 1的：1）身心健康； 2）脆弱； 3）频繁的急诊护理； 4）多药； 或5）伯宁的高处治疗。我们将使用电子健康记录中的数据确定合格的患者， 在筛查时通过自我报告的信息确认，并将验证者1：1随机将 通常的护理控制。主要结果是物理HRQOL的变化从基线到12个月，测量 与SF-12。次要结果包括心理HRQOL（SF-12）和医疗保健利用的变化。 在Re-Aim框架的指导下，我们将使用定量和定性方法来评估障碍和 促进者在关键利益相关者群体之间实施。这些数据将为未来的实施提供信息。 下一步/实施：此混合类型1试验将提供为更广泛的VA做准备所需的数据 实施如果干预有效。实施活动将与现有本地协调 和国家运营伙伴。如果干预措施无效，目标2和3将阐明退伍军人如何 将来可以更好地支持多个多发病。