1/2 Video Telehealth Pulmonary Rehabilitation to Reduce Hospital Readmission in Chronic Obstructive Pulmonary Disease (Tele-COPD)

项目概要/摘要 慢性阻塞性肺疾病（COPD）的急性加重导致显著的发病率和 医疗保健费用，特别是需要住院治疗的严重加重。传统的支气管扩张剂和抗- 炎性药物以及监测和治疗症状的方案对减少 入院再入院率仍然高得令人无法接受，因此需要采取其他办法。在这 在这方面，肺康复（PR）是非常有效的，并与80%的住院减少有关 rates.成功完成PR还与生活质量、呼吸困难、 以及运动耐力。尽管有这些好处，最近的研究强调了PR的转诊率非常低 总体而言，住院后低至1.9%，未完成率高达60%。适应性差 社区中的PR是由于可用性和可访问性方面的障碍以及自然减员。的 美国的公共关系中心数量不足，且大多分布在城市地区。 此外，多种社会经济和医疗障碍阻碍了获得PR，并导致高辍学率。 需要新的策略来减少COPD患者的再入院率，并增加PR， 服务不足的城市和农村地区。鉴于现有资源的稀缺性， 护理提供模式受到挑战，人们正在努力寻找替代的、具有成本效益的方法， 为更多符合条件的患者提供医疗服务。为了克服社会经济和物质上的 公关障碍，我们假设，视频远程医疗干预，将提供公关到病人的家， 无论地理位置如何，都将减少COPD患者的再入院率，并降低呼吸系统发病率。到 为了验证我们的假设，我们提出了一项前瞻性随机对照3期多中心临床试验，比较 实时视频远程医疗PR干预加标准治疗与单独标准治疗， 具体目标：（1）确定视频远程医疗公关干预是否减少了30天的全因再入院， （2）评估视频远程医疗PR的效果 对COPD患者出院后呼吸困难和呼吸生活质量的干预;（3）评价COPD患者出院后呼吸困难和呼吸生活质量的变化。 远程保健干预的成本效益。实现这项研究的目标将产生重大影响。 降低COPD再入院率，以及向COPD患者提供PR的方式发生范式转变， 特别是那些居住在偏远和农村地区，肺部康复机会有限的人。

Project Summary/Abstract Acute exacerbations of chronic obstructive pulmonary disease (COPD) result in significant morbidity and healthcare costs, especially severe exacerbations that require hospitalization. Traditional bronchodilators and anti- inflammatory medications, as well as programs to monitor and treat symptoms, have a modest effect on reducing hospital admissions. Readmission rates remain unacceptably high, so alternative approaches are needed. In this regard, pulmonary rehabilitation (PR) is remarkably effective, and is associated with an 80% reduction in admission rates. Successful completion of PR is also associated with substantial improvements in quality of life, dyspnea, as well as exercise tolerance. Despite these benefits, recent studies have highlighted very poor referral rates for PR overall and as low as 1.9% post-hospitalization, and non-completion rates as high as 60%. The poor adaptation of PR in the community is due to a combination of barriers in availability and accessibility, as well as attrition. The number of PR centers in the United States is inadequate, and these centers are mostly distributed in urban areas. In addition, multiple socioeconomic and medical barriers hinder access to PR, and contribute to high drop-out rates. New strategies are needed to reduce hospital readmission in COPD, and to increase the delivery of PR to underserved urban as well as rural areas in the community. Given the scarcities in existing resources, conventional models of care delivery are being challenged, and attempts are being made to find alternative, cost-effective ways of delivering healthcare to a larger number of eligible patients. To overcome the socioeconomic and physical barriers to PR, we hypothesize that a video telehealth intervention that will deliver PR to the patient's home, regardless of geographic location, will reduce hospital readmissions in COPD, and reduce respiratory morbidity. To test our hypothesis we propose a prospective randomized controlled phase 3 multicenter clinical trial comparing a real-time video telehealth PR intervention plus standard of care versus standard of care alone, with the following Specific Aims: (1) To determine if a video telehealth PR intervention reduces 30-day all-cause readmissions in patients hospitalized for acute exacerbation of COPD, (2) To evaluate the effects of the video telehealth PR intervention on dyspnea and respiratory quality of life in COPD post hospital discharge, and (3) To evaluate the cost-effectiveness of the telehealth intervention. Accomplishment of the aims of this study will result in a significant reduction in COPD readmission rates, and a paradigm shift in the way PR is delivered to patients with COPD, especially those that reside in remote and rural areas with limited access to pulmonary rehabilitation.