Identifying facilitators and barriers to heart failure care in Haiti to adapt a community-based intervention

确定海地心力衰竭护理的促进因素和障碍，以适应基于社区的干预措施

• 批准号: 10469694
• 负责人: Gene Fazil Kwan
• 金额: $ 16.51万
• 依托单位: BOSTON MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-01 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10469694
• 关键词: Address; Administrator; Admission activity; Adult; Ambulatory Care; Ambulatory Care Facilities; Attitude; Behavior; Biosocial; Cardiovascular Diseases; Caring; Cause of Death; Cessation of life; Chronic Care; Clinic; Clinic Visits; Code; Collaborations; Communities; Community Health Aides; Complex; Consolidated Framework for Implementation Research; Development; Effectiveness; Ensure; Evidence based intervention; Focus Groups; Fogarty International Center; Funding; Goals; Government; Grant; HIV; Haiti; Haitian; Health; Health Services Accessibility; Health system; Heart failure; Hospital Referrals; Hospitalization; Hospitals; Hybrids; Inpatients; Internal Medicine; Intervention; Intervention Studies; Interview; Link; Literature; Medical; Medicine; Mentors; Mentorship; Methods; Mission; Modeling; National Heart, Lung, and Blood Institute; Nongovernmental Organizations; Nurses; Patient Care; Patients; Personal Satisfaction; Provider; Public Health; Publishing; Qualitative Research; Quality of life; Records; Research; Research Priority; Rural; Sampling; Scientist; Series; Structure; Surveys; System; Testing; Time; Training; Translational Research; United States National Institutes of Health; Visit; Work; acceptability and feasibility; base; cardiovascular health; career; community engagement; cost effective; cultural health; design; disability; effectiveness outcome; evidence base; experience; follow-up; global health; group intervention; health disparity; implementation outcomes; implementation science; improved; innovation; low and middle-income countries; low income country; multidisciplinary; novel; skills; social; success; therapy design

PROJEC T SUMMAR Y This proposal seeks to evaluate the biosocially complex interaction between heart failure (HF) patients and their health system to guide evidence-based interventions to improve wellbeing for patients in low- and middle- income countries (LMIC). Cardiovascular disease (CVD) causes 30% of all deaths in Haiti; nearly 4-times more deaths than human immunodeficiency virus (HIV). Our published work has shown that heart failure (HF) is the leading cause – 37% – of adult internal medicine hospitalizations. However, the crucial link from inpatient to outpatient care is not well developed as two-thirds of HF patients are not successfully linked to outpatient care, where linkage is defined as having a clinic visit within 30 days after discharge. My long-term career goal is to develop as an implementation scientist and test strategies to improve linkage to care for CVD in low-income countries. The objective of this application is to first identify barriers to poor linkage for patients hospitalized with HF in rural Haiti, and then to adapt and pilot an evidence-based CHW intervention to address the barriers based on models for HIV. My overarching hypotheses are that complex combinations of identifiable and modifiable biosocial and health system barriers influence how rural Haitian HF patients access care and that an adapted CHW intervention will enhance linkage to chronic care. The proposed research will be conducted in rural Haiti in collaboration with Partners In Health and Zanmi Lasante. Aim 1: Identify facilitators and barriers to outpatient care linkage for hospitalized HF patients. By assessing the salience of established and novel facilitators and barriers to HF care linkage from multiple perspectives, this aim will investigate what factors influence patients' decision and capacity to return for follow-up care. I will conduct a series of focus group discussions with 24-30 patients (stratified by those linked and not linked); 12-15 CHWs; and 8-12 doctors and nurses. I will identify central concepts categorized by the Consolidated Framework for Implementation Research, and also generate and refine hypotheses about facilitators and barriers to linkage. Aim 2: Adapt a CHW intervention to improve linkage to care for HF patients. By applying the findings from Aim 1 using the ADAPT-ITT framework, which has been successfully used to adapt care linkage strategies for HIV patients, I will modify an existing evidence-based CHW intervention used in HIV care for patients discharged after a HF admission based on the facilitators and barriers identified in Aim 1. Aim 3: Pilot the CHW intervention to assess feasibility and acceptability. I will pilot the adapted CHW linkage support intervention (Aim 2) with a sample of patients with HF (n=30) to improve linkage to care. I will use qualitative interviews and surveys among the patients, CHWs, doctors, nurses, and health system administrators to assess the acceptability, appropriateness, feasibility, and fidelity of the pilot intervention among all stakeholders. I will explore secondary effectiveness outcomes including linkage among the intervention group compared with a reference group of 30 HF patients.

PROJEC

项目成果

Burden of non-communicable diseases from infectious causes in 2017: a modelling study.

• DOI: 10.1016/s2214-109x(20)30358-2
• 发表时间: 2020-12
• 期刊: The Lancet. Global health
• 作者: Coates MM;Kintu A;Gupta N;Wroe EB;Adler AJ;Kwan GF;Park PH;Rajbhandari R;Byrne AL;Casey DC;Bukhman G
• 通讯作者: Bukhman G

Availability of equipment and medications for non-communicable diseases and injuries at public first-referral level hospitals: a cross-sectional analysis of service provision assessments in eight low-income countries.

• DOI: 10.1136/bmjopen-2020-038842
• 发表时间: 2020-10-10
• 期刊: BMJ open
• 影响因子: 2.9
• 作者: Gupta N;Coates MM;Bekele A;Dupuy R;Fénelon DL;Gage AD;Getachew T;Karmacharya BM;Kwan GF;Lulebo AM;Masiye JK;Mayige MT;Ndour Mbaye M;Mridha MK;Park PH;Dagnaw WW;Wroe EB;Bukhman G
• 通讯作者: Bukhman G

The COVID-19 Pandemic: A Massive Threat for Those Living With Cardiovascular Disease Among the Poorest Billion.

• DOI: 10.1161/circulationaha.120.047969
• 发表时间: 2020-11-17
• 期刊: Circulation
• 影响因子: 37.8
• 作者: Klassen SL;Kwan GF;Bukhman G
• 通讯作者: Bukhman G

Prioritizing Health-Sector Interventions for Noncommunicable Diseases and Injuries in Low- and Lower-Middle Income Countries: National NCDI Poverty Commissions.

• DOI: 10.9745/ghsp-d-21-00035
• 发表时间: 2021-09-30
• 期刊: Global health, science and practice
• 作者: Gupta N;Mocumbi A;Arwal SH;Jain Y;Haileamlak AM;Memirie ST;Larco NC;Kwan GF;Amuyunzu-Nyamongo M;Gathecha G;Amegashie F;Rakotoarison V;Masiye J;Wroe E;Koirala B;Karmacharya B;Condo J;Nyemazi JP;Sesay S;Maogenzi S;Mayige M;Mutungi G;Ssinabulya I;Akiteng AR;Mudavanhu J;Kapambwe S;Watkins D;Norheim O;Makani J;Bukhman G;NCDI Poverty National Commissions Authorship Group; NCDI Poverty Network Secretariat
• 通讯作者: NCDI Poverty National Commissions Authorship Group; NCDI Poverty Network Secretariat

Protocolized emergency department observation care improves quality of ischemic stroke care in Haiti.

规范化的急诊科观察护理提高了海地缺血性中风护理的质量。

• DOI: 10.1016/j.afjem.2020.05.007
• 发表时间: 2020
• 期刊: African journal of emergency medicine : Revue africaine de la medecine d'urgence
• 作者: Rouhani,ShadaA;Marsh,ReganH;Rimpel,Linda;Anderson,Kathryn;Outhay,Malena;Edmond,MarieCassandre;Checkett,KeeganA;Berkowitz,AaronL;Kwan,GeneF;Baugh,ChristopherW;Schuur,JeremiahD
• 通讯作者: Schuur,JeremiahD