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
基本信息
- 批准号:10420988
- 负责人:
- 金额:--
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 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:
- 关键词:AddressAdverse effectsBehavioralCaringChronicChronic DiseaseClinic VisitsClinicalCommunitiesCommunity OutreachComplexDataDiseaseEducationElectronic Health RecordEmergency CareEmergency department visitEnrollmentEvaluationFaceFutureGoalsGuidelinesHealthHealth Care CostsHealth Services AccessibilityHealth behaviorHigh PrevalenceHybridsImpaired healthIndividualInpatientsInterventionIntervention TrialLife StyleLinkMeasuresMediatingMedical Care TeamMental HealthModelingOutcomePatient Self-ReportPatient-Centered CarePatient-Focused OutcomesPatientsPersonal SatisfactionPersonsPlanning TechniquesPolypharmacyPopulationPractice ManagementPrimary Health CareProblem SolvingProviderQualitative MethodsQuality of lifeRandomizedReach Effectiveness Adoption Implementation and MaintenanceResearchResourcesSF-12Self EfficacySelf ManagementServicesSocial supportStandardizationTechnologyTestingText MessagingTimeTrainingTranslatingTreatment ProtocolsUnited States Department of Veterans AffairsVeteransVeterans Health AdministrationVisitWorkbasebody systemcare deliverycare outcomesclinical carecostdisabilityeffectiveness evaluationeffectiveness implementation studyeffectiveness-implementation RCTelectronic dataemotional symptomexperiencefrailtyfuture implementationhealth care service utilizationhealth differencehealth related quality of lifehigh riskhybrid type 1 trialimplementation facilitatorsimplementation interventionimprovedin-home careinnovationintervention costintervention participantsmeetingsmortalitymultiple chronic conditionspatient orientedpatient-clinician communicationpatient-level barrierspeerpeer supportphysical conditioningphysical symptomprimary outcomeprogramspsychological distresspsychosocialremote deliveryrural areascreeningsecondary outcomeshared decision makingsuccesstelehealthtelehealthcaretreatment as usualvideo visitvirtualvirtual healthcare
项目摘要
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)患者患有多重疾病
项目成果
期刊论文数量(0)
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Kristen E Gray其他文献
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{{ truncateString('Kristen E Gray', 18)}}的其他基金
Enhancing social support for diabetes self-management among men and women Veterans
加强对男性和女性退伍军人糖尿病自我管理的社会支持
- 批准号:
10295035 - 财政年份:2017
- 资助金额:
-- - 项目类别:
Enhancing social support for diabetes self-management among men and women Veterans
加强对男性和女性退伍军人糖尿病自我管理的社会支持
- 批准号:
10186508 - 财政年份:2017
- 资助金额:
-- - 项目类别:
Enhancing social support for diabetes self-management among men and women Veterans
加强对男性和女性退伍军人糖尿病自我管理的社会支持
- 批准号:
10392958 - 财政年份:2017
- 资助金额:
-- - 项目类别:
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