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Social Support, Self-Management, and Hospital Use for Heart Failure

心力衰竭的社会支持、自我管理和医院使用

基本信息

批准号：
7572047
负责人：
Raegan Winston Durant
金额：
$ 5.95万
依托单位：
UNIVERSITY OF ALABAMA AT BIRMINGHAM
依托单位国家：
美国
项目类别：
财政年份：
2008
资助国家：
美国
起止时间：
2008-09-30 至 2010-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7572047
关键词：
Accounting Address Adherence Adoption Adult Affect African American Age Behavior Caring Chronic Disease Clinical Cohort Studies Communities Community Health Comorbidity Conceptions Daily Data Data Analyses Disease Management Elderly End Point Enrollment Expenditure Family Foundations Friends Future Goals Health Services Accessibility Healthcare Heart failure Hospitalization Hospitals Inpatients Intervention Interview Knowledge Length of Stay Malignant Neoplasms Measures Mediating Mediator of activation protein Medicare Modeling Morbidity - disease rate Myocardial Infarction Outpatients Participant Patients Persons Pharmaceutical Preparations Physicians Population Psychosocial Factor Public Health Race Rate Research Risk Factors Role Self Management Services Social support Sodium-Restricted Diet Surveys Teaching Hospitals Telephone Testing Trust Weight Work base beneficiary burden of illness cohort cost design follow-up functional status mortality older patient payment programs prospective racial difference

项目摘要

DESCRIPTION (provided by applicant): Elderly African Americans with heart failure are more likely to be hospitalized for heart failure compared to their white counterparts. However, African Americans with heart failure also frequently have similar or even lower 1- year mortality compared to white heart failure patients. Previous studies have shown that factors such as post-discharge care, the unique role of heart failure among African Americans, comorbidities, and access to care may account for the some of disparities in hospital use. However, fewer studies have examined non-clinical factors such as patient social support. Social support is essential to the successful outpatient management of heart failure, particularly among the elderly. Social support, provided by family or friends, may facilitate the adoption of and adherence to self-management behaviors such as checking daily weights and maintaining a low sodium diet. Social support may decrease heart failure morbidity through this mediating role in the relationship between self-management behaviors and hospital use for heart failure. The proposed research will include a prospective cohort study of African American and white adults over age 40 previously hospitalized for heart failure 1) to assess the relationship between social support and heart failure 2) to assess the relationship between self-management behaviors and hospital use for heart failure 3) to measure the extent to which social support mediates the relationship between self-management behavior and hospital use for heart failure. Study participants will be selected using administrative data on hospital discharges from a single large teaching hospital. At study entry, a survey instrument will be administered with validated scales to measure social support and self-management behaviors. In addition, other data on trust in physicians, comorbidities, functional status, medication use and adherence will be collected via the survey. At the end of the 1-year follow-up period, administrative hospital data will be used to measure hospital use for heart failure at the same teaching hospital for all study participants during the previous 12 months. In the data analysis, multivariable modeling will be used to examine the independent relationships of both social support and self- management behaviors with hospital use for heart failure in this diverse cohort. Furthermore, sequential model building will be utilized to determine if social support is a mediator in the relationship between self-management behaviors and hospital use for heart failure. The proposed research will help to elucidate the relationships among these patient factors and hospital use for heart failure. Additionally, the research should inform future work in the design of community-based interventions to augment or optimize social support in efforts to address racial disparities in hospital use for heart failure. PUBLIC HEALTH RELEVANCE: Heart failure affects about 2.6% of adults in the US and is the leading cause of hospitalizations annually among Medicare beneficiaries. Racial disparities in hospital use for heart failure reflect a higher burden of disease among elderly African Americans with heart failure compared to whites. The elucidation of the role of social support as it relates to self-management behaviors and hospital use for heart failure is essential to the creation and implementation of community-based interventions to address these health care disparities.

描述（由申请人提供）：与白人相比，患有心力衰竭的老年非裔美国人更有可能因心力衰竭住院。然而，与白人心力衰竭患者相比，患有心力衰竭的非洲裔美国人的 1 年死亡率也常常相似甚至更低。先前的研究表明，出院后护理、心力衰竭在非裔美国人中的独特作用、合并症和获得护理的机会等因素可能是医院使用情况存在一些差异的原因。然而，很少有研究检查患者社会支持等非临床因素。社会支持对于心力衰竭门诊的成功治疗至关重要，尤其是老年人。家人或朋友提供的社会支持可能有助于采取和坚持自我管理行为，例如检查每日体重和保持低钠饮食。社会支持可以通过在自我管理行为与心力衰竭医院使用之间的关系中发挥中介作用来降低心力衰竭发病率。拟议的研究将包括一项针对 40 岁以上因心力衰竭住院的非裔美国人和白人成年人的前瞻性队列研究 1) 评估社会支持与心力衰竭之间的关系 2) 评估自我管理行为与心力衰竭医院使用之间的关系 3) 衡量社会支持在多大程度上调节自我管理行为与心力衰竭医院使用之间的关系。研究参与者将使用一家大型教学医院的出院管理数据来选择。在研究开始时，将使用经过验证的量表来管理调查工具，以衡量社会支持和自我管理行为。此外，还将通过调查收集有关对医生的信任、合并症、功能状态、药物使用和依从性的其他数据。在 1 年随访期结束时，将使用医院行政数据来衡量过去 12 个月内所有研究参与者在同一教学医院治疗心力衰竭的医院使用情况。在数据分析中，多变量模型将用于检查社会支持和自我管理行为与医院在这个不同队列中治疗心力衰竭的独立关系。此外，将利用顺序模型构建来确定社会支持是否是自我管理行为与心力衰竭医院使用之间关系的中介因素。拟议的研究将有助于阐明这些患者因素与心力衰竭医院使用之间的关系。此外，该研究应该为未来设计基于社区的干预措施提供信息，以增强或优化社会支持，努力解决心力衰竭医院使用中的种族差异。公共卫生相关性：心力衰竭影响美国约 2.6% 的成年人，是每年 Medicare 受益人住院的主要原因。心力衰竭住院治疗的种族差异反映出，与白人相比，患有心力衰竭的老年非裔美国人的疾病负担更高。阐明社会支持与自我管理行为和心力衰竭医院使用相关的作用对于制定和实施基于社区的干预措施以解决这些医疗保健差异至关重要。