Increasing Adherence to Pulmonary Rehabilitation after COPD-related Hospitalizations

项目摘要/总结 尽管已证实有益处，但接受肺康复（PR）的COPD患者比例仍为 非常小。目前基于中心的PR计划模式未能满足许多患者的需求， 慢性阻塞性肺病最常见的病人出席障碍是前往中心为基础的计划，特别是对体弱 需要交通帮助的重度COPD患者。家庭式的，无人监督的公关 作为医院项目的替代模式，已被发现是安全的， 有效特别是，据报道，住院后的PR是预防复发的最有效干预措施。 然而，现实情况是，很多时候这不是一个可行的干预措施，因为只有4%的人 符合条件的个人能够在入院后坚持PR（出于多种原因）。虽然COPD是 负责每年近70万次住院治疗，其中许多住院治疗， COPD每年直接医疗费用的很大一部分是潜在的可预防的再入院。 在这个奖项中，我们计划将健康教练添加到公关中，以促进基于我们的 先前的研究（R 01 HL 09468）显示，该研究可高度有效地减少COPD再次住院， 持续改善QOL。我们提出了一个简单的远程公关系统，可以填补实践的空白 基于我们以前的工作（R44 HL 114162;克雷默，PI;苯并）。一个完善的家庭为基础的公关将受到考验 在R61期开始的一项有150名患者参加的具有良好把握度的2期随机临床试验中， 在R33期间完成。

PROJECT ABSTRACT / SUMMARY Despite proven benefits, the proportion of people with COPD who receive Pulmonary Rehabilitation (PR) is very small. The current model of a center-based PR program fails to address the needs of many patients with COPD. The most common patient barrier to attendance is travel to center-based programs, particularly for frail patients with more severe COPD who need transportation assistance. Home-based, unsupervised PR has been proposed as an alternative model to hospital-based programs and has been found to be safe and effective. In particular PR post-hospitalization has been reported as the most effective intervention to prevent a hosptal readmission; however, the reality is that many times this is not a feasible intervention as only 4% of eligible individuals are able to adhere to PR after a hospital admission (for multiple reasons). While COPD is responsible for nearly 700,000 hospitalizations annually, many of these hospitalizations, which account for a large proportion of the annual direct medical costs of COPD, are potentially preventable readmissions. In this award we plan to add Health Coaching to PR to promote a behavior change based on our previous work (R01 HL09468), that was shown to be highly effective to decrease COPD re-hospitalizations and sustainably improve QOL. We propose a simple system of Remote PR that may fill the practice gap based on our previous work (R44 HL114162; Kramer, PI; Benzo). A refined home-based PR will be tested in a well-powered phase 2 randomized clinical trial of 150 patients that will be started in the R61 period and finalized in the R33 period.