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

• 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
• 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

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）：与白人同行相比，患有心力衰竭的非裔美国人心力衰竭更可能因心力衰竭住院。但是，与白人心力衰竭患者相比，患有心力衰竭的非裔美国人经常具有相似甚至更低的1年死亡率。先前的研究表明，诸如入院后护理，非裔美国人心力衰竭的独特作用，合并症以及获得护理的独特作用可能占医院使用的某些差异。但是，更少的研究检查了非临床因素，例如患者社会支持。社会支持对于成功的门诊治疗心力衰竭至关重要，尤其是在老年人中。家人或朋友提供的社会支持可能有助于采用和遵守自我管理行为，例如检查日常体重和保持低钠饮食。社会支持可能通过这种中介作用在自我管理行为与医院用于心力衰竭之间的关系中的作用来降低心力衰竭的发病率。拟议的研究将包括对40岁以前因心力衰竭住院的非洲裔美国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医院使用心力衰竭之间的关系3）测量社会支持介导自我管理行为与医院使用心脏失败之间的关系的程度。研究参与者将使用一家大型教学医院出院的医院出院进行管理数据。在研究条目中，将使用经过验证的量表管理调查工具，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医师，合并症，功能状况，用药使用和依从性的其他信任数据。在为期1年的随访期结束时，在过去的12个月中，所有研究参与者的行政医院数据将用于衡量同一教学医院的医院使用。在数据分析中，将使用多变量建模来检查社会支持和自我管理行为与这种多样的队列中心力衰竭使用的独立关系。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医院使用心力衰竭之间关系的中介。拟议的研究将有助于阐明这些患者因素之间的关系和医院用于心力衰竭。此外，该研究应在设计基于社区的干预措施的设计中为未来的工作提供信息，以增强或优化社会支持，以解决治疗医院用于心力衰竭的种族差异。公共卫生相关性：心力衰竭影响美国大约2.6％的成年人，是医疗保险受益人每年住院的主要原因。与白人相比，医院用于心力衰竭的种族差异反映了患有心力衰竭的非裔美国人的疾病负担。阐明社会支持与自我管理行为有关的作用和心力衰竭的医院使用，对于解决这些基于社区的干预措施以解决这些医疗保健差异至关重要。