TRANSLATING RESEARCH: PATIENT DECISION SUPPORT/COACHING

转化研究：患者决策支持/指导

• 批准号: 6528215
• 负责人: Margaret M Holmes-Rovner
• 金额: $ 43.31万
• 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/6528215
• 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.

这项名为“患者决策支持和指导”的拟议项目是一项为期三年零两个月的新方法试验，旨在改善因心肌梗死住院后二级预防的使用。研究人员此前开发并试行了一项计划，该计划使用一本简短的患者决策支持手册和护士电话咨询来“指导”患者开始和继续二级预防。这项名为心脏院后康复计划(HARP)的干预措施让患者、HARP护士和治疗医生(S)参与审查有关医学和行为二级预防策略的证据，并为患者的康复制定计划。然后，驻在医院的护士顾问在1、2、4周时进行随访电话，以帮助解决问题并加强使用HARP手册做出的决定。护士还“指导”患者在即将到来的初级保健和心脏病医生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和对照社区。这项研究将招募所有说英语的无肾功能衰竭的心肌梗死患者，他们的病情足够好，可以在医院接受采访并同意参与。这项研究的具体目的是：1)确定与常规护理相比，使用HARP是否能提高心肌梗塞后医生开药的比率；2)确定在住院3个月和12个月后，与对照组相比，参加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，参加HARP是否会带来更好的健康和福祉；4)确定与常规护理相比，参加HARP是否会提高人们对心脏健康能力的感知和对决策的参与；5)评估与常规护理相比，HARP的成本效益。HARP干预的重要性在于其开发决策支持和指导干预的潜力，以提高卫生保健系统在正确的时间、可靠地向正确的患者提供正确的护理的能力。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建立在以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。这种干预是在社区实践环境中开发的，以最大限度地减少对医院和办公室例行公事的干扰。如果HARP在心肌梗塞后被证明是成功的，它可以作为其他循证干预的原型交付工具。