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

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而住院。然而，与白人心力衰竭患者相比，患有心力衰竭的非裔美国人的一年死亡率也经常相似，甚至更低。以前的研究表明，出院后护理、非裔美国人心力衰竭的独特作用、合并症以及获得护理的机会等因素可能解释了医院使用方面的一些差异。然而，较少的研究考察了患者社会支持等非临床因素。社会支持对于心力衰竭的成功门诊治疗至关重要，尤其是在老年人中。由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，如检查日常体重和保持低钠饮食。社会支持可能通过在自我管理行为与医院治疗心力衰竭之间的关系中的中介作用来降低心力衰竭的发病率。这项拟议的研究将包括一项针对40岁以上曾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住院治疗之间的关系；3)社会支持在多大程度上调节自我管理行为与心力衰竭住院治疗之间的关系。研究参与者将使用单一大型教学医院的医院出院管理数据进行选择。在研究开始时，将使用具有有效量表的调查工具来衡量社会支持和自我管理行为。此外，关于对医生的信任、合并症、功能状态、药物使用和依从性的其他数据将通过调查收集。在为期一年的随访期结束时，将使用行政医院数据来衡量所有研究参与者在过去12个月内在同一家教学医院因心力衰竭而住院的情况。在数据分析中，将使用多变量建模来检验社会支持和自我管理行为与不同队列中心力衰竭医院使用情况的独立关系。此外，将利用序贯模型构建来确定社会支持是否在自我管理行为和医院心力衰竭使用之间的关系中起中介作用。这项拟议的研究将有助于阐明这些患者因素与医院治疗心力衰竭之间的关系。此外，这项研究应该为未来基于社区的干预设计工作提供信息，以增强或优化社会支持，努力解决医院使用心力衰竭的种族差异。与公共健康相关：在美国，心力衰竭影响了大约2.6%的成年人，是每年医疗保险受益人住院的主要原因。因心力衰竭而住院的种族差异反映出，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重。阐明社会支持在自我管理行为和医院治疗心力衰竭方面的作用，对于创建和实施以社区为基础的干预措施以解决这些卫生保健差距至关重要。

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.