Development of a Tailored Intervention to Increase Veteran Enrollment in Cardiac Rehabilitation

制定定制干预措施以增加退伍军人参与心脏康复的人数

• 批准号: 10547741
• 负责人: JUSTIN M BACHMANN
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-01-01 至 2025-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10547741
• 关键词: Acute myocardial infarction; Address; Behavior Therapy; Behavioral; Belief; Cardiac; Cardiac rehabilitation; Cardiovascular Diseases; Cardiovascular system; Caring; Clinical; Clinical Trials; Data; Development; Education; Effectiveness of Interventions; Eligibility Determination; Enrollment; Event; Exercise; Five-Year Plans; Goals; Health; Health Services; Health Services Research; Healthcare Systems; Home; Hospitalization; Individual; Intervention; Intervention Trial; Interview; Investigator-Initiated Research; K-Series Research Career Programs; Knowledge; Link; Measures; Mental Depression; Methodology; Methods; Modeling; Motivation; Myocardial Ischemia; Nature; Nurses; Obesity; Outpatients; Patient Participation; Patients; Prevalence; Quality of Care; Quality of life; Recurrence; Research; Research Personnel; Risk Factors; Sampling; Self Efficacy; Services; Social support; Specialist; Structure; Surveys; Tennessee; Testing; Training; United States Department of Veterans Affairs; Veterans; Veterans Health Administration; acceptability and feasibility; behavior change; cardiovascular risk factor; career development; clinically significant; cohort; data integration; effectiveness evaluation; experience; formative assessment; implementation science; improved; innovation; insight; instrument; intervention effect; mortality; observational cohort study; outpatient programs; participant enrollment; programs; psychosocial; randomized, clinical trials; skills; success; theories; therapy design; therapy development; usability

Background: This Veterans Affairs (VA) Health Services Research & Development Career Development Award resubmission is a five-year plan that will enable the candidate, a staff cardiologist and specialist in cardiac rehabilitation (CR) at the VA Tennessee Valley Healthcare System, to develop and implement interventions to increase CR enrollment in Veterans. CR is an outpatient program including prescriptive exercise and cardiac risk factor education that is an essential therapy for patients with cardiovascular disease. This proposal will develop a tailored intervention to increase Veteran enrollment in CR. Significance/Impact: CR is widely underutilized, with less than 20% of eligible patients enrolling in CR programs nationally. CR utilization is particularly low among Veterans, with only 10% of eligible Veterans enrolling in CR programs. Though CR referral rates have risen substantially over the past decade, CR enrollment has remained static. It is imperative to study barriers to CR enrollment among Veterans that have already been referred to CR and develop interventions tailored to these individual barriers. Innovation: The applicant will develop a tailored intervention for increasing CR enrollment using the Obesity- Related Behavioral Intervention Trials model, a conceptual model for intervention development, as well as the information-motivation-behavioral skills model, a theory of behavior change that allows individual tailoring. Linking these models will produce new knowledge regarding behavioral intervention methodology as well as an innovative clinical intervention that can be delivered by nurses and other clinical staff at VA facilities. The proposed intervention aligns with current VA initiatives by supporting CR enrollment wherever is most convenient for Veterans (including VA CR programs, non-VA CR programs, and home-based CR programs). Specific Aims: Aims 1 and 2 comprise a sequential explanatory mixed methods study to evaluate barriers to CR enrollment among Veterans. The purpose of Aim 1 is to quantify barriers to CR in 100 Veterans hospitalized with ischemic heart disease using the previously validated Beliefs About Cardiac Rehabilitation Scale (BACRS). The purpose of Aim 2 is to reveal additional barriers to outpatient CR enrollment through qualitative interviews in 30 Veterans from Aim 1 who did not enroll in CR. Aim 3 focuses on the iterative development of a tailored intervention to increase outpatient CR enrollment in 3 groups of 5 hospitalized Veterans, characterizing the intervention’s feasibility and acceptability. In Aim 4, the tailored intervention will undergo proof-of-concept testing in a non-randomized group of 25 Veterans hospitalized with ischemic heart disease. The applicant hypothesizes that these Veterans will have a clinically significant improvement in BACRS summary scores after the intervention, representing a decrease in perceived barriers to CR. Methodology: Aim 1 will quantitate the burden of CR barriers among Veterans by evaluating distributions of BACRS summary scores and subscales. In Aim 2, the applicant will use intensity sampling to purposefully select Veterans with the lowest individual BACRS subscale scores (and highest perceived barriers to CR) from the Aim 1 cohort for semi-structured qualitative interviews. Aim 3 will use mixed data from Aims 1 and 2 and serial formative evaluations to inform the iterative development of a tailored intervention. In Aim 4, the BACRS will be administered before and after the intervention, characterizing the intervention’s effect on perceived barriers to CR enrollment as measured by the BACRS summary score. Implementation/Next Steps: The applicant will align the study activities with the QUERI Implementation Roadmap and convene a Stakeholder Engagement Panel to ensure that the tailored intervention is developed with maximum generalizability to other VA facilities. Findings from the proposed study will inform a wide range of initiatives related to CR enrollment among Veterans and will be used to conduct a randomized clinical trial of the tailored intervention within the context of an Investigator Initiated Research application.

背景：退伍军人事务部(VA)卫生服务研发职业发展 重新提交奖项是一个五年计划，将使候选人，一名心脏病专家和专家 在退伍军人事务部田纳西谷医疗系统开发和实施心脏康复(CR) 提高退伍军人CR入学率的干预措施。CR是一项门诊计划，包括处方 运动和心脏危险因素教育是心血管疾病患者的基本治疗方法。 这项提案将制定一项量身定做的干预措施，以增加CR退伍军人的入学人数。 意义/影响：CR普遍未得到充分利用，只有不到20%的符合条件的患者参加了CR 全国范围内的节目。退伍军人的CR利用率特别低，只有10%的符合条件的退伍军人 注册参加CR课程。尽管CR转介率在过去十年中大幅上升，但 招生人数一直保持不变。当务之急是研究在有以下条件的退伍军人中加入CR的障碍 已经提交公约与建议委员会，并制定针对这些个别障碍的干预措施。 创新：申请者将开发一种量身定做的干预措施，以利用肥胖来增加CR入学人数- 相关行为干预试验模型，干预发展的概念模型，以及 信息-动机-行为技能模型，一种允许个人量身定做的行为变化理论。 将这些模型联系起来将产生关于行为干预方法学的新知识，以及 创新的临床干预措施，可由退伍军人管理局的护士和其他临床工作人员提供。这个 建议的干预措施与当前的退伍军人管理局计划保持一致，在任何地方都支持CR登记 方便退伍军人(包括退伍军人CR计划、非VA CR计划和基于家庭的CR计划)。 具体目标：目标1和目标2包括一项顺序的解释性混合方法研究，以评估 退伍军人中的CR登记。目标1的目的是量化100名退伍军人的CR障碍 使用先前证实的心脏康复信念入院治疗缺血性心脏病 规模(BACRS)。目标2的目的是通过以下方式揭示门诊CR登记的其他障碍 对来自AIM 1的30名未参加CR的退伍军人进行定性访谈。目标3侧重于迭代 制定量身定制的干预措施，以增加3组5名住院患者的门诊CR登记人数 退伍军人，表征了干预的可行性和可接受性。在目标4中，量身定做的干预措施将 对25名因缺血性心脏病住院的退伍军人进行概念验证测试 疾病。申请人假设这些退伍军人在临床上将有显著的改善 干预后BACRS总分，代表认知障碍的减少。 方法：目标1将通过评估退伍军人中CR障碍的分布来量化CR障碍的负担 BACRS总分和分量表。在目标2中，申请者将使用强度采样来有目的地 选择个人BACRS子量表得分最低(以及对CR的感知障碍最高)的退伍军人 目标1为半结构化定性访谈的队列。目标3将使用来自目标1和目标2的混合数据 一系列形成性评估，为量身定制的干预措施的迭代开发提供信息。在目标4中，BACR 将在干预前和干预后实施，以表征干预对感知的影响 通过BACRS汇总分数衡量的CR注册障碍。 实施/下一步：申请者将使研究活动与QUERI实施保持一致 制定路线图并召开利益相关者参与小组会议，以确保制定量身定制的干预措施 最大限度地推广到其他退伍军人管理局。拟议中的研究结果将提供广泛的信息 与退伍军人CR登记相关的倡议，并将用于进行一项随机临床试验 在调查员发起的研究申请的背景下的量身定做的干预。