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: 6846877
• 负责人: LANI M ZIMMERMAN
• 金额: $ 33.81万
• 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/6846877
• 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术后患者的有效随访和管理在整个康复过程中非常重要。具体地说，这项研究将试图弥补目前文献中与后续干预措施的影响有关的空白，以增强冠脉搭桥术人群的康复结果。本实验的主要目的是采用随机两组重复测量设计，在出院时、术后3周和6周、3周和6个月进行测量，以检验症状管理家庭护理干预(SMHCNI)对老年CABG患者康复结局的影响。一组将接受干预和常规护理(RC)，另一组将仅接受RC。主要目的是确定干预组是否会表现出更好的生理功能(减少了对身体功能的症状干扰(减少了对身体功能的症状干扰；SF 36分量表：身体、角色-身体和活力的评分更高，活动和运动能量消耗更高)；更好的生理调节(减少了对身体功能的症状干扰；SF 36分量表的分数更高；角色-情绪、社会、精神和活力)；以及更少的术后问题(如感染、肺部积液、心率节律问题)。次要目标的其他结果是：更低的医疗保健利用水平(即，去看医疗保健提供者的次数更少，急诊科就诊次数更少，家庭健康就诊次数更少，再住院人数更少)；以及更高的患者满意度(功能水平和接受的护理水平)。此外，本研究将审查调解(评估功能水平和接受的护理)和GT的潜在影响；此外，本研究将审查调解的潜在影响(评估功能水平和接受的护理)。此外，本研究还将考察中介变量(症状评估、自我效能感)和调节变量(参与心脏康复)与干预对上述结果的潜在影响。这种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，每天可以下载到一个免费的安全互联网网站，卫生保健提供者不能用于医院后的后续护理。为期6周的SMHCNI是根据Bandura(1986)对自我效能的定义设计的，该定义是为了增强对一个人的信念，即组织和执行管理未来情景所需的来源和行动的能力。初步数据显示，这些患者回家时出现了症状管理问题，但如果及早发现和处理，这些问题引起的并发症是可以预防的。使用后续干预，如SMHCNI，预计将导致更好的功能，症状的管理和较少的术后问题。此外，还将描述对HCU、患者满意度和自我效能作为变量的更好理解。