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Understanding Patient Management of COPD Exacerbations

了解 COPD 急性加重的患者管理

基本信息

批准号：
9084798
负责人：
Vincent S Fan
金额：
--
依托单位：
VA PUGET SOUND HEALTHCARE SYSTEM
依托单位国家：
美国
项目类别：
财政年份：
2016
资助国家：
美国
起止时间：
2016-05-01 至 2020-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9084798
关键词：
Accident and Emergency department Accident and Emergency department Affect Affect Albuterol Albuterol Antibiotics Antibiotics Appointment Appointment Back Back Behavior Behavior Breathing Breathing Caregivers Caregivers Caring Caring Case Manager Case Manager Cause of Death Cause of Death Chronic Care Chronic Obstructive Airway Disease Chronic Obstructive Airway Disease Cognitive Cognitive Cohort Studies Colorado Colorado Comorbidity Coughing Coughing Data Data Data Analyses Data Analyses Early identification Early identification Early treatment Early treatment Emergency Medicine Emergency Medicine Emergency department visit Emergency department visit Emotional Emotional Enrollment Enrollment Ensure Ensure Evaluation Evaluation Event Event Future Future Goals Goals Health Services Accessibility Health Services Accessibility Home environment Home environment Hospitalization Hospitalization Hour Hour Inhalators Inhalators Intervention Intervention Intervention Trial Intervention Trial Interview Interview Lead Lead Lung Lung Measures Measures Medical Medical Medical Care Team Medical Care Team Mental disorders Mental disorders Methods Methods Modeling Modeling Monitor Monitor Oral Oral Outcome Outcome Outpatients Outpatients Participant Participant Patient Care Patients Patients Persons Persons Prednisone Prednisone Primary Health Care Primary Health Care Prospective cohort Prospective cohort study Questionnaires Questionnaires Reporting Reporting Research Research Research Training Research Training Respiratory Signs and Symptoms Respiratory Signs and Symptoms Risk Risk Sampling Sampling Self Management Self Management Severities Severities Shortness of Breath Shortness of Breath Social support Social support Spirometry Spirometry Sputum Sputum Steroids Steroids Structure Structure Symptoms Symptoms System System Telephone Testing Testing Time Time Transportation Transportation Veterans Veterans Visit Visit Voice Voice Work Work asthma inhaler asthma inhaler base base care seeking care seeking cohort cohort contextual factors contextual factors follow-up follow-up health care delivery health care delivery high risk high risk hospitalization rates information gathering medical specialties medical specialties mild cognitive impairment mild cognitive impairment mortality mortality novel novel novel strategies novel strategies prevent prevent programs prospective response response self-management program sound sound stem stem therapy development therapy development

项目摘要

DESCRIPTION (provided by applicant): Prompt treatment of chronic obstructive pulmonary disease (COPD) exacerbations with oral steroids and/or antibiotics, ideally within 3 days of onset of symptoms, can decrease the severity and duration of exacerbations and may reduce the risk of COPD hospitalizations. One approach to accomplishing early treatment is to use a supported self-management program that includes an action plan with a home prescription for steroids and/or antibiotics. However, recent studies suggest that supported self-management programs may not be appropriate for the majority of COPD patients, and may in fact be harmful. Therefore, a new approach is needed that does not rely on patient self-management. This study will examine Veterans' care-seeking behaviors focusing on Veterans perceived need for care and perceived access to care and how these factors delay seeking care for COPD exacerbations, increasing the risk for hospitalizations. This study will also evaluate one novel approach of identifying early exacerbations through the use of a remote inhaler monitoring system. There is little data on the factors that influence when patients decide to seek care. To obtain this needed data, this study will enroll a cohort of 410 Veterans with COPD at high-risk for exacerbations and follow every patient for 1 year. The Specific Aims are: 1) Examine the barriers to seeking care for COPD exacerbations or worsening breathing; 2) Test the use of a real-time remote inhaler monitor to identify early exacerbations. 410 participants at VA Puget Sound and the VA Eastern Colorado will be enrolled in the study. For Aim 1a and 1b, approximately 60 participants who reported a COPD exacerbation and were either hospitalized, treated as outpatients, or did not seek treatment will participate in an in-depth semi-structured interview by a trained research staff to understand how they responded to their worsening symptoms and decided whether to seek care. When available, the caregivers for these Veterans will be interviewed to obtain their perspective on the exacerbation event. In Aim 1c, participants will attend one in-person baseline visit to complete spirometry and baseline questionnaires. Participants will be contacted every 2 weeks for 1 year using an interactive voice response system that will screen for COPD exacerbations with 4 yes/no questions. Participants with a positive screen will be called back by research staff to obtain additional detailed information on the exacerbation and how it was treated. Data analysis will examine where access to care and baseline factors are associated with a delay in treatment. In Aim 2, 200 participants from Aim 1 will use an inhaler monitor with their albuterol inhaler, which will transmit data in real-time about their daily inhaler use. They will use this monitor for the 12-month follow-up period. Data analysis will measure ability of a change in albuterol use to predict patient reported COPD exacerbations to determine the appropriate cut-offs that can be used in a future intervention trial. These aims will provide critical detailed information on how best to intervene to ensure prompt identification and treatment of COPD exacerbations without relying on self-management. New health care delivery approaches will assist Veterans in early identification of exacerbations and provide early access to care that can be integrated into the VA primary care, emergency medicine and pulmonary specialty care settings.