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Rehabilitation in Safety-Net Environments (RISE) for COPD

慢性阻塞性肺病安全网环境康复 (RISE)

基本信息

批准号：
10557812
负责人：
Neeta Thakur
金额：
$ 68.83万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-02-01 至 2027-01-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10557812
关键词：
Address Adherence Adoption Advocate Affect Body Weight Caring Cause of Death Chronic Obstructive Pulmonary Disease Clinic Clinical Clinical Trials Communities Control Groups County Coupled Disease Disease Outcome Educational process of instructing Elements Enrollment Environment Equipment Evidence based intervention Evidence based program Exercise Face Geographic Locations Geography Goals Health Health Benefit Health Resources Healthcare Systems Hospitalization Individual Intervention Interview Leadership Life Link Low income Maintenance Medicare Methods Mission Monitor Morbidity - disease rate Neighborhoods Outcome Oxygen Participant Pathway interactions Patients Population Primary Care Process Qualitative Methods Quality of life Randomized Reach, Effectiveness, Adoption, Implementation, and Maintenance Rehabilitation Centers Rehabilitation therapy Resources Risk Reduction San Francisco Self Management Services Site Social Environment Social support Structure Symptoms Testing Underinsured Vulnerable Populations Waiting Lists Walking arm beneficiary contextual factors cost design economic disparity effective intervention effectiveness evaluation effectiveness testing effectiveness/implementation design evidence base exercise training experience food insecurity functional decline functional improvement functional outcomes health care settings heart rate monitor high risk housing instability implementation barriers implementation evaluation implementation intervention improved improved outcome innovation intervention delivery intervention effect low health literacy neighborhood disadvantage older patient patient engagement patient population patient-level barriers peer pilot trial portability post intervention preservation primary outcome programs pulmonary rehabilitation resistance exercise safety net screening secondary outcome social social vulnerability stressor symptomatic improvement system-level barriers three-arm trial treatment as usual

项目摘要

Project Abstract Individuals with moderate-to-severe chronic obstructive pulmonary disease (COPD) are at high risk for rapid functional decline and hospitalization. Pulmonary rehabilitation is one of the few interventions that has been shown to effectively modify the course of COPD and improve health outcomes; however, challenges in implementation and access to this high resource intervention in real-life settings have led to low-availability and engagement due to both healthcare system-level and patient-level barriers. To address barriers specific to low- resourced healthcare settings, we developed COPD Wellness with patient and clinical stakeholders. This 10- week community-based program retains key elements of pulmonary rehabilitation (exercise training, self- management, and peer social support), but is designed to be portable and feasible to deliver in diverse settings. While COPD Wellness addresses many system-level barriers, it does not directly address patient-level barriers. Lower levels of adherence are common across low-income, low health literacy communities, reflecting the burden of competing socio-environmental stressors that interfere with the ability to carry out rehabilitation activities and independently contribute to poor outcomes in COPD. We adapted the evidence-based resource support program, Health Advocates (HA), for the unmet social needs of older patients with COPD as a strategy to improve acceptance, adherence, and impact of pulmonary rehabilitation programs (Plus+). The proposed study will directly test the benefit of the COPD Wellness and Plus+ Program relative to usual care and estimate the added benefit of the HA in COPD Wellness Plus+ to COPD Wellness alone in a three-arm, randomized waitlist-controlled trial conducted in three geographically isolated urban primary care sites that provide care for some of the most socially vulnerable patient populations with COPD. In this Type 1 effectiveness- implementation hybrid design, we aim to 1) determine the effectiveness of COPD Wellness and Plus+ to improve functional and symptom outcomes; and, using a mixed-methods approach 2) to evaluate the implementation of COPD Wellness and Plus+ across study sites applying the RE-AIM and CFIR frameworks to identify additional barriers and enablers of intervention implementation and patient acceptance and adherence. COPD Wellness Plus+ was designed to specifically address barriers to rehabilitation and function within low-resourced healthcare settings. If effective, the COPD Wellness Plus+ program can offer a feasible pathway for broader implementation of low intensity pulmonary rehabilitation regionally and nationally in the U.S.

项目摘要患有中度至重度慢性阻塞性肺疾病（COPD）的个体处于快速呼吸的高风险中。功能下降和住院治疗。肺康复是为数不多的干预措施，显示出有效地改变COPD的病程并改善健康结果;然而，在现实生活环境中实施和获得这种高资源干预导致了低可用性，由于医疗保健系统和患者层面的障碍，为解决低收入群体面临的具体障碍，我们与患者和临床利益相关者一起开发了COPD Wellness。这10- 一周的社区计划保留了肺康复的关键要素（运动训练，自我，管理和同伴社会支持），但其目的是便携式和可行的，以提供在不同的环境。虽然COPD健康解决了许多系统层面的障碍，但它并不直接解决患者层面的障碍。低收入、低健康素养社区的依从性水平较低，这反映了相互竞争的社会环境压力源的负担，干扰了开展康复的能力活动和独立导致COPD的不良结局。我们采用了基于证据的资源支持计划，健康倡导者（HA），为老年COPD患者的未满足的社会需求作为一种策略提高肺康复计划（Plus+）的接受度、依从性和影响力。拟议的研究将直接测试COPD健康和Plus+计划相对于常规护理的益处并在三组中估计HA在COPD Wellness Plus+中相对于单独COPD Wellness的额外获益，在三个地理上隔离的城市初级保健中心进行的随机等待名单对照试验，为一些在社会上最脆弱的COPD患者群体提供护理。在第1类有效性中- 实施混合设计，我们的目标是1）确定COPD Wellness和Plus+的有效性，以提高功能和症状结果;以及，使用混合方法方法2）评估实施情况应用RE-AIM和CFIR框架，在研究中心的COPD Wellness和Plus+中确定其他干预实施的障碍和推动因素以及患者的接受和依从性。COPD健康 Plus+旨在专门解决资源匮乏的医疗保健中康复和功能障碍设置.如果有效，COPD Wellness Plus+计划可以为更广泛的实施提供可行的途径低强度肺康复在美国的地区和国家