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

基本信息

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
项目类别：
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

项目摘要

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 T摘要y 该建议旨在评估心力衰竭（HF）患者和他们的卫生系统指导基于证据的干预措施，以改善低和中间患者的福祉收入国家（LMIC）。心血管疾病（CVD）导致所有在海地所有死亡的30％；近4次死亡比人类免疫缺陷病毒（HIV）。我们发表的工作表明心力衰竭（HF）是主要原因 - 37％ - 成人内科住院治疗。但是，从住院到由于HF患者中有三分之二与门诊护理没有成功，门诊护理的发展尚未得到很好的发展。将连锁定义为在出院后30天内进行诊所访问。我的长期职业目标是发展为实施科学家和测试策略以改善联系照顾低收入国家的CVD。该应用的目的是首先确定贫穷的障碍与HF住院的患者的连锁干预以根据艾滋病毒模型解决障碍。我的总体假设是复杂的识别和可修改的生物社会和卫生系统障碍的组合影响海地的粗糙HF 患者获得护理，并且改编的CHW干预将增强与慢性护理的联系。提议研究将与Haiti与Health和Zanmi Lasante合作进行Rough Haiti进行。目标1：确定住院HF患者的促进者和门诊护理连接的障碍。经过从多个角度评估已建立和新颖的促进者和HF护理联系的障碍的显着性，这 AIM将研究哪些因素会影响患者的决策和返回后续护理的能力。我将进行与24-30名患者进行了一系列焦点小组讨论（由链接的患者分层）； 12-15 CHW；以及8-12位医生和护士。我将确定由合并框架分类的中心概念实施研究，还产生和完善有关促进者和链接障碍的假设。 AIM 2：调整CHW干预措施以改善与HF患者护理的联系。通过应用调查结果从AIM 1使用Adapt-ITT框架，该框架已成功用于调整护理链接策略对于HIV患者，我将修改用于患者的HIV护理中现有的基于证据的CHW干预措施基于AIM 1中确定的促进者和障碍后，HF入院后出院。目标3：试行CHW干预以评估可行性和可接受性。我会驾驶改编的chw 连锁支持干预（AIM 2）与HF患者（n = 30）样本，以改善与护理的联系。我会在患者，CHW，医生，护士和卫生系统中使用定性访谈和调查管理员评估飞行员干预的可接受性，适当性，可行性和保真度在所有利益相关者中。我将探讨次要有效性结果，包括干预组与30例HF患者的参考组相比。

项目成果

期刊论文数量（14）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

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
影响因子：
0
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

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
影响因子：
0
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

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

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
影响因子：
0
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