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.

项目 T总结 该提案旨在评估心力衰竭（HF）患者和心力衰竭患者之间生物社会复杂的相互作用。 他们的卫生系统指导循证干预措施，以改善中低收入患者的福祉 收入国家（LMIC）。海地 30% 的死亡是由心血管疾病 (CVD) 造成的；近 4 倍 死亡人数高于人类免疫缺陷病毒（HIV）。我们发表的研究表明，心力衰竭（HF）是 成人内科住院的主要原因（37%）。然而，从住院到住院的关键环节 门诊护理尚未得到很好的发展，因为三分之二的心力衰竭患者没有成功地与门诊护理联系起来， 其中链接的定义是出院后 30 天内到诊所就诊。 我的长期职业目标是发展成为一名实施科学家并测试改善联系的策略 照顾低收入国家的 CVD。该应用程序的目的是首先确定贫困人口面临的障碍 为海地农村地区因心力衰竭住院的患者建立联系，然后调整和试点基于证据的社区卫生工作 基于艾滋病毒模型的干预措施，以解决障碍。我的总体假设非常复杂 可识别和可改变的生物社会和卫生系统障碍的组合如何影响海地农村HF 患者获得护理，经过调整的社区卫生工作者干预措施将加强与慢性护理的联系。拟议的 该研究将与 Partners In Health 和 Zanmi Lasante 合作在海地农村地区进行。 目标 1：确定住院心力衰竭患者门诊护理联系的促进因素和障碍。经过 从多个角度评估心力衰竭护理联系中现有的和新颖的促进因素和障碍的显着性，本研究 目标将调查哪些因素影响患者的决定和返回后续护理的能力。我将进行一次 与 24-30 名患者进行的一系列焦点小组讨论（按相关和不相关的患者分层）； 12-15 名社区卫生工作者； 以及8-12名医生和护士。我将确定综合框架分类的中心概念 实施研究，并生成和完善有关联系的促进因素和障碍的假设。 目标 2：采用社区卫生工作者干预措施，改善心力衰竭患者护理的联系。通过应用研究结果 使用 ADAPT-ITT 框架实现目标 1，该框架已成功用于调整护理联系策略 对于艾滋病毒患者，我将修改现有的用于艾滋病毒患者护理的社区卫生工作者干预措施 根据目标 1 中确定的促进因素和障碍，在 HF 入院后出院。 目标 3：试点社区卫生工作者干预措施以评估可行性和可接受性。我将试点改造后的 CHW 对心力衰竭患者样本 (n=30) 进行联系支持干预（目标 2），以改善与护理的联系。我会 对患者、社区卫生工作者、医生、护士和卫生系统进行定性访谈和调查 管理人员评估试点干预的可接受性、适当性、可行性和保真度 所有利益相关者之间。我将探讨次要有效性结果，包括 干预组与由 30 名心力衰竭患者组成的参考组进行比较。

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