Symptom Management Intervention in Elderly CABG Patients

老年冠状动脉搭桥术患者的症状管理干预

• 批准号: 6751399
• 负责人: LANI M ZIMMERMAN
• 金额: $ 0.97万
• 依托单位: UNIVERSITY OF NEBRASKA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2002
• 资助国家: 美国
• 起止时间: 2002-05-01 至 2007-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6751399
• 关键词: behavioral /social science research tag; coronary bypass; early diagnosis; functional ability; health behavior; human old age (65+); human subject; human therapy evaluation; nursing intervention; outcomes research; patient care management; patient oriented research; postoperative complications; postoperative state; telemedicine

Effective follow-up and management of elderly post-CABG patients is important in the overall recovery process. Specifically, this study will attempt to bridge the gap in current literature related to the impact of follow-up interventions to enhance recovery outcomes in the CABG population. The major purpose of this experimental study is to test the effects of the symptom management home care nursing intervention (SMHCNI) on recovery outcomes of elderly CABG patients using a randomized, two group (N=284) repeated measures design with measurements at discharge, at 3 and 6 weeks, and 3 and 6 months post- operatively. One group will receive the intervention and routine care (RC) and the other group will receive only RC. The major aim will be to determine if the intervention group will demonstrate: better physiological functioning (decreased symptom interference on physical functioning (decreased symptom interference on physical functioning; better scores on the SF 36 subscales: physical, role-physical and vitality, and increased activity and exercise energy expenditure); better physiological conditioning (decreased symptom interference on physical functioning; better scores on the SF 36 subscales; role-emotional, social, mental, and vitality); and fewer post-operative problems (e.g., infections, fluid in lungs, heart rate rhythm problems). Additional outcomes for secondary aims are: lower levels of health care utilization [HCU] (i.e., fewer number of visits to health care providers, fewer number of emergency department visits, fewer number of home health visits, fewer rehospitalizations); and higher patient satisfaction (with level of functioning and care received). In addition this study will examine the potential effects of mediating (evaluation of level of functioning and care received)> In addition this study will examine the potential effects of mediating (evaluation of level of functioning and care received). In addition this study will examine the potential effects of mediating (evaluation of symptoms, and perceived self-efficacy, and moderating variables (participation in cardiac rehabilitation) with the intervention on outcomes identified above. The intervention will be delivered using a device called the Health Buddy that is attached to the patient's telephone line, able to download to a free secure Internet site daily, and cannot be used by health care providers for post-hospital follow up care. The 6- week SMHCNI was designed using Bandura's (1986) definition of self- efficacy which is to enhance the beliefs in ones capabilities to organize and execute the sources and actions required to manage prospective situations. Preliminary data have shown that these patients are going home with symptom management problems, but that complications arising from these problems might be prevented with early detection and management. Using a follow-up intervention such as the SMHCNI is expected to result in better functioning, management of symptoms and fewer post-operative problems. Also, a better understanding of HCU, patient satisfaction, and self-efficacy as variables will be described.

对老年CABG术后患者进行有效的随访和管理在整个恢复过程中非常重要。具体而言，本研究将试图弥合当前文献中与随访干预对提高CABG人群恢复结局的影响相关的差距。本实验研究的主要目的是采用随机、两组（N=284）重复测量设计，在出院时、术后3周和6周以及术后3个月和6个月测量症状管理家庭护理干预（SMHCNI）对老年CABG患者恢复结局的影响。一组将接受干预和常规护理（RC），另一组仅接受RC。主要目的将是确定干预组是否会表现出：更好的生理功能（对身体功能的症状干扰减少（对身体功能的症状干扰减少; SF 36分量表评分更高：身体、角色-身体和活力，活动和运动能量消耗增加）;生理调节更好（对身体功能的症状干扰减少; SF 36分量表评分更好;角色-情感、社会、心理和活力）;以及术后问题更少（例如，感染、肺部积液、心率节律问题）。次要目标的其他结果是：较低的卫生保健利用水平[HCU]（即，减少了对保健提供者的访问次数，减少了急诊室访问次数，减少了家庭保健访问次数，减少了再住院次数）;提高了患者满意度（对功能和所接受的护理水平）。此外，这项研究将检查调解的潜在影响（评估功能和接受的护理水平）。此外，本研究将检查中介（症状评估和自我效能感）和调节变量（参与心脏康复）对上述结果的干预的潜在影响。干预将使用一种名为Health Buddy的设备进行，该设备连接到患者的电话线上，每天可以下载到免费的安全互联网网站，并且不能由医疗保健提供者用于医院后的后续护理。6周的SMHCNI是根据班杜拉（1986）对自我效能的定义设计的，自我效能是增强对自己组织和执行管理预期情况所需的资源和行动的能力的信念。初步数据显示，这些患者回家时存在症状管理问题，但这些问题引起的并发症可以通过早期发现和管理来预防。使用后续干预措施，如SMHCNI，预计将导致更好的功能，症状管理和更少的术后问题。此外，更好地了解HCU，病人满意度和自我效能作为变量将被描述。