TRANSLATING RESEARCH: PATIENT DECISION SUPPORT/COACHING

转化研究：患者决策支持/指导

• 批准号: 6283519
• 负责人: Margaret M Holmes-Rovner
• 金额: $ 61.55万
• 依托单位: MICHIGAN STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2000
• 资助国家: 美国
• 起止时间: 2000-09-30 至 2003-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6283519
• 关键词: behavioral /social science research tag; cardiovascular disorder prevention; clinical research; decision making; health behavior; health services research tag; human subject; human therapy evaluation; myocardial infarction; nursing intervention; patient care management; physicians; problem solving

The proposed project, "Patient Decision Support and Coaching," is a three-year and two month trial of a novel approach to improving the use of secondary prevention following hospitalization for myocardial infarction. The investigators previously developed and pilot tested a program that uses a brief patient decision- support booklet and nurse telephone counseling to "coach" patients to begin and continue secondary prevention. The intervention, the Heart After-hospital Recovery Planner (HARP), engages the patient, HARP nurse and treating physician(s) in reviewing evidence about medical and behavioral secondary prevention strategies and developing a plan for the patient's recovery. Nurse counselors, based in the hospital, then make follow-up telephone calls at 1, 2, 4 weeks to help solve problems and reinforce decisions made using the HARP booklet. Nurses also "coach" patients to ask questions at upcoming visits to both primary care and cardiology or cardiac surgeon physicians. The project will serve as a prototype of a combined "decision support and coaching" intervention. The study is a two-community study, comparing intervention and control communities in Michigan. The study will enroll all English-speaking patients with confirmed myocardial infarction without renal failure who are well enough to be interviewed in-hospital and consent to participate. The specific aims of the research are to: 1) Determine whether use of HARP leads to improved rates of post-MI physician medication prescribing compared with usual care; 2) Determine whether patients who participate in HARP improve medical and behavioral secondary prevention compared with controls at 3 months and 12 months following hospitalization; 3) Determine whether participation in HARP leads to improved health and well-being, compared with usual care; 4) Determine whether participation in HARP leads to improved perceived heart health competence and participation in decision-making, compared with usual care; 5) Evaluate the cost-utility of HARP compared to usual care. The importance of the HARP intervention lies in its potential to develop decision support and coaching interventions to improve the ability of the health care system to deliver the right care to the right patient, reliably, at the right time. Nationwide, both medical and behavioral secondary prevention is under- utilized. HARP builds on previous research in patient decision- support and telephone counseling to encourage implementation of secondary prevention strategies by patients and physicians. The intervention has been developed in community practice settings to intrude minimally into hospital and office routines. Should HARP prove successful post-MI, it can serve as a prototype delivery vehicle for other evidence-based interventions.

拟议的项目“患者决策支持和指导”是一项为期3年零2个月的新方法试验，旨在改善心肌梗死住院后二级预防的使用。研究人员先前开发并试点了一项计划，该计划使用简短的患者决策支持小册子和护士电话咨询来“指导”患者开始并继续进行二级预防。这项干预措施，即心脏住院后康复计划（HARP），使患者、HARP护士和治疗医生参与审查有关医疗和行为二级预防策略的证据，并制定患者康复计划。然后，驻在医院的护士咨询师在第1、2、4周进行后续电话咨询，以帮助解决问题，并加强使用HARP小册子做出的决定。护士还“指导”患者在即将到来的初级保健和心脏病学或心脏外科医生的访问中提出问题。该项目将作为“决策支持和指导”相结合的干预措施的原型。这项研究是一项两个社区的研究，比较了密歇根州的干预社区和控制社区。该研究将招募所有说英语的确诊无肾功能衰竭的心肌梗死患者，这些患者身体状况良好，可以在医院接受采访并同意参与研究。本研究的具体目的是：1)确定与常规护理相比，使用HARP是否能提高心肌梗死后医生的药物处方率；2)在住院后3个月和12个月，与对照组相比，参与HARP的患者是否改善了医疗和行为二级预防；3)确定与常规护理相比，参与HARP是否能改善健康和福祉；4)确定与常规护理相比，参与HARP是否能提高感知心脏健康能力和参与决策；5)与常规护理相比，评估HARP的成本-效用。HARP干预措施的重要性在于，它有潜力开发决策支持和指导干预措施，以提高卫生保健系统的能力，从而在正确的时间可靠地向正确的患者提供正确的护理。在全国范围内，医疗和行为二级预防都没有得到充分利用。HARP建立在先前对患者决策支持和电话咨询的研究基础上，以鼓励患者和医生实施二级预防策略。该干预措施是在社区实践环境中开发的，以尽量减少对医院和办公室日常工作的干扰。如果HARP在mi后证明是成功的，它可以作为其他循证干预措施的原型交付工具。