Rehabilitation in Safety-Net Environments (RISE) for COPD

项目摘要 患有中到重度慢性阻塞性肺疾病(COPD)的人快速发作的风险很高。 功能衰退和住院。肺康复是为数不多的干预措施之一 被证明有效地改变了COPD的病程并改善了健康结果；然而， 在现实生活环境中实施和访问这种高度的资源干预导致了低可用性和 由于医疗系统级别和患者级别的障碍而产生的参与度。要解决特定于低- 在资源丰富的医疗保健环境下，我们与患者和临床利益相关者共同开发了COPD健康。这10个字- 一周以社区为基础的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)，但设计为便于在不同的环境中提供。 虽然COPD Wellness解决了许多系统层面的障碍，但它并没有直接解决患者层面的障碍。 低水平的坚持在低收入、低健康素养社区中很常见，反映了 干扰康复能力的相互竞争的社会环境应激源的负担 活动和独立导致慢性阻塞性肺病的不良结局。我们调整了基于证据的资源 健康倡导者(HA)支持计划，将未满足的老年COPD患者的社会需求作为一项战略 提高对肺康复计划(Plus+)的接受度、依从性和影响。 拟议的研究将直接测试COPD Wellness and Plus+计划相对于常规护理的好处 并估计HA在COPD Wellness Plus+中单独在三个臂中对COPD Wellness的额外好处， 在三个地理位置隔绝的城市初级保健地点进行的随机等待名单对照试验 为一些社会上最脆弱的慢性阻塞性肺病患者群体提供护理。在这种类型1的有效性中- 实施混合设计，我们的目标是1)确定COPD Wellness和Plus+的有效性以改进 功能和症状结果；并使用混合方法2)评估 跨研究站点应用RE-AIM和CFIR框架以确定其他 干预措施实施以及患者接受和坚持的障碍和推动因素。慢性阻塞性肺病健康状况 Plus+旨在专门解决低资源医疗保健中的康复和功能障碍 设置。如果有效，COPD Wellness Plus+计划可以为更广泛的实施提供一条可行的途径 低强度肺康复在美国的地区性和全国性。

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.