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: 8281421
• 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/8281421
• 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.

说明(由申请人提供)：项目概述在家庭陪伴就诊如何影响护理质量指标方面存在根本差距，例如以患者为中心的沟通(例如，反映对患者价值观的尊重并将患者的关切和偏好纳入决策的沟通)，特别是对于心力衰竭患者--由于其高发病率和死亡率，心力衰竭是一个特别脆弱的群体。该项目的长期目标是改善心力衰竭(心力衰竭患者)的护理质量和提供以及随后的健康结果。这里的总体目标，也是我们追求长期目标的下一步，是确定家庭陪伴是否影响就诊期间的护理过程，并利用这些信息为干预发展提供信息。这项拟议研究的基本原理是，一旦我们知道家庭成员是如何影响护理质量和提供的，我们就可以履行政策制定者和医疗保健模式的行动呼吁，“与患者及其家人合作，为持续的医疗保健创建一个综合、连贯的计划。”研究策略建立在这样一个中心假设之上，即家庭成员参与临床护理将促进患者与提供者的沟通，并潜在地改善随后的心力衰竭自我管理行为。为了实现我们的总体目标，我们的具体目标是：1)调查家人陪伴对以患者为中心的沟通的影响，通过以下录音带评估：以患者为中心的比率(推动患者议程的沟通与促进提供者议程的沟通的比率)、患者激活和参与行为、医生促进和患者激活行为；2)评估与患者教育和咨询有关的提供者沟通(例如，体重、饮食、症状管理、体力活动和服药依从性)的影响；3)在定性数据和AIMS 1、2结果的基础上，利用干预图谱(IM)设计家庭参与的心力衰竭干预措施，并对干预措施进行预试。受指导的研究、正式的教学和计划中的演示/发表将为作为临床科学家的独立资助奠定基础。