Family members influence quality and delivery of care for heart failure patients

家庭成员影响心力衰竭患者的护理质量和提供

• 批准号: 8089857
• 负责人: CRYSTAL WILEY CENE
• 金额: $ 13.97万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-06-14 至 2014-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8089857
• 关键词: Affect; American; Behavior; Cardiovascular Diseases; Caring; Chronic Disease; Chronically Ill; Client satisfaction; Clinical; Communication; Companions; Counseling; Data; Decision Making; Diet; Disease; Family; Family member; Funding; Goals; Health; Health Personnel; Heart failure; Home visitation; House Call; Hypertension; Incidence; Intervention; Interview; Knowledge; Life; Maps; Measures; Medical; Mentors; Mission; Morbidity - disease rate; Observational Study; Outcome; Patient Education; Patient-Centered Care; Patients; Performance; Physical activity; Physicians; Policy Maker; Population; Process; Provider; Public Health; Publications; Quality of Care; Research; Scientist; Self Care; Self Management; Social support; Staging; Testing; Visit; Vulnerable Populations; Work; base; care delivery; career; clinical care; design; family influence; health care delivery; health care model; improved; medication compliance; mortality; outcome forecast; patient oriented; preference; research study; symptom management; therapy design; therapy development

DESCRIPTION (provided by applicant): PROJECT SUMMARY There is a fundamental gap in how the presence of family companions in medical visits influences indicators of quality of care, such as patient-centered communication (e.g., communication that reflects respect for patients' values and incorporates patient's concerns and preferences into decision-making), specifically for patients with heart failure - a particularly vulnerable population by virtue of its high morbidity and mortality. The long-term goals of this project are to improve the quality and delivery of care and subsequent health outcomes for Heart Failure (HF patients). The overall objective here, which is our next step in pursuit of our long-term goal, is to determine whether family accompaniment influences processes of care within the medical visit and use this information to inform intervention development. The rationale for the proposed research is that once we know how family members influence quality and delivery of care we can fulfill the call to action of policy makers and health care models to "create an integrated, coherent plan for ongoing medical care in partnership with patients and their families." The research strategy is built around the central hypothesis that involvement of family members in clinical care will facilitate patient-provider communication and potentially improve subsequent HF self-management behaviors. The specific aims to achieve our overall objective are: 1) To investigate the impact of family companion's presence on patient centered communication as assessed by the following audio-tape measures: the patient-centeredness ratio (ratio of communication that furthers the patient's agenda to communication that furthers the provider's agenda), patient activation and engagement behaviors, and physician facilitation and patient activation behaviors; 2) To assess the impact of family companion's presence on provider communication related to patient education and counseling about HF self-management behaviors (e.g., weighing, diet, symptom management, physical activity, and medication adherence); and 3) To use intervention mapping (IM) to design a family-involved HF intervention based on qualitative data and results of Aims 1 and 2, and pre-test the intervention. The mentored research, formal didactics, and planned presentations/publications will set the stage for independent funding as a clinician-scientist. PUBLIC HEALTH RELEVANCE: PROJECT NARRATIVE: The proposed research is relevant to public health by seeking to improve the delivery of patient/family centered care for patients with chronic illness by understanding how the patient-physician interaction is influenced by family member accompaniment to medical visits. Thus, the proposed research is relevant to NHLBI's mission to enhance the health of patients living with heart failure so that they can live longer and more fulfilling lives.

描述（由申请人提供）：项目总结在医疗访问中家庭伴侣的存在如何影响护理质量指标方面存在根本性差距，例如以患者为中心的沟通（例如，（c）在决策过程中体现对患者价值观的尊重并将患者的关切和偏好纳入决策过程的沟通），特别是针对心力衰竭患者--由于其高发病率和死亡率，这是一个特别脆弱的人群。该项目的长期目标是改善心力衰竭（HF患者）的护理质量和交付以及随后的健康结果。这里的总体目标，这是我们追求我们的长期目标的下一步，是确定家庭陪伴是否影响医疗访问中的护理过程，并使用此信息为干预措施的制定提供信息。这项拟议研究的基本原理是，一旦我们知道家庭成员如何影响护理质量和提供护理，我们就可以履行政策制定者和医疗保健模式的行动呼吁，“与患者及其家属合作，为持续的医疗保健制定一个综合的、连贯的计划。“研究策略是围绕着一个中心假设建立的，即家庭成员参与临床护理将促进患者与提供者的沟通，并可能改善随后的HF自我管理行为。本研究的主要目的是：1）通过以下的录音测量方法，探讨家庭伴侣的存在对以病人为中心的沟通的影响：（促进患者议程的通信与促进提供者议程的通信的比率）、患者激活和参与行为以及医生促进和患者激活行为; 2）评估家庭伴侣的存在对与患者教育和关于HF自我管理行为的咨询相关的提供者沟通的影响（例如，体重、饮食、症状管理、体力活动和药物依从性）;以及3）使用干预映射（IM）基于目标1和2的定性数据和结果设计涉及家庭的HF干预，并对干预进行预测试。指导的研究，正式的教学法和计划的演讲/出版物将为作为临床科学家的独立资助奠定基础。 公共卫生相关性：项目叙述：拟议的研究是相关的公共卫生，寻求改善患者/家庭为中心的护理慢性病患者的交付，了解患者与医生的互动是如何影响家庭成员陪同医疗访问。因此，拟议的研究与NHLBI的使命有关，即增强心力衰竭患者的健康，使他们能够活得更长，更充实。