Multicomponent Intervention to Decrease COPD-Related Hospitalizations

描述（由申请人提供）：慢性阻塞性肺疾病（COPD）是世界范围内最常见的慢性疾病之一，也是住院和再入院的常见原因。因慢性阻塞性肺病恶化而住院治疗对患者来说是一件重要的事情，因为这可能标志着疾病末期的开始，并与生活质量和生存机会的显著下降有关。这是医疗保健系统的一个重要事件，因为住院费用占美国copd相关费用的70%。基于一个经过验证的理论框架，先前的文献和我们的初步数据，我们设计了一种COPD的多组分干预措施，该干预措施将在出院时开始，旨在减少再住院。干预措施将包括与一名护士的长期接触，该护士将整合肺部康复，将通过使用动机性访谈提高自我效能来促进自我管理，并将增加患者/家庭连续体与初级保健团队之间的沟通。本研究拟采用随机对照试验（RCT）设计检验以下假设：(1)干预组的住院率和住院次数比对照组至少低20%。(2)在6个月和12个月的随访中，干预组的身体活动水平（平均每日步数、中等强度体力活动分钟数（METS 2.5）和主动能量消耗）高于对照组。目的1：确定随访12个月后COPD恶化出院时开始的干预措施对住院率和住院人数的影响。目的2：通过活动监测仪在3,6和12个月评估COPD加重住院后干预对增加和维持身体活动的影响。目的3：确定干预对3、6和12个月时身体活动和疾病管理自我效能的影响。目标4：确定干预措施对3、6和12个月时健康状况的影响。目的5（探索性）：确定住院、低体力活动的预测因素，以及体力活动、自我效能和健康状况变化的预测因素。确定预测因素将允许更有力的干预和关注那些不活动或再次住院的高风险患者。变化的预测因子将识别出对类似干预措施有更高反应机会的患者（随着时间的推移，研究结果的变化更高）。

DESCRIPTION (provided by applicant): Chronic obstructive pulmonary disease (COPD) is one of the most common chronic diseases worldwide and is a frequent cause of hospital admissions and readmissions. Hospitalization for a COPD exacerbation is an important event for patients because it may signal the beginning of the terminal phase of illness and is associated with a significant decline in the quality of life and chances of survival. It is an important event for the healthcare system because hospitalization accounts for 70% of COPD-related costs in the United States. Based on a validated theoretical framework, previous literature and on our preliminary data we designed a multi-component intervention for COPD which will be initiated at hospital discharge aimed to decrease re- hospitalization. The intervention will include permanent access to a nurse that will integrate pulmonary rehabilitation, will promote self-management by increasing self efficacy using motivational interviewing and will increase communication between the patient/family continuum and the primary care team. This study plan to test the following hypotheses using a randomized control trial (RCT)design: (1) The rate and number of hospitalizations will be at least 20% lower in the intervention group than in the control group (2) At 6-month and 12-month follow-ups, the physical activity level measured in terms of the average number of steps , minutes spent in physical activities of moderate intensity (METS>2.5) per day and active energy expenditure will be higher in the intervention group than in the control group. Aim 1: To determine the impact of the intervention initiated at the time of hospital discharge from a COPD exacerbation on the rate and number of hospitalizations after 12 months of follow-up. Aim 2: To determine the impact of the intervention on increasing and maintaining physical activity after a hospitalization for a COPD exacerbation assessed by an activity monitor at 3, 6 and 12 months. Aim 3: To determine the impact of the intervention on self efficacy for physical activity and disease management at 3, 6 and 12 months. Aim 4: To determine the impact of the intervention on health status at 3, 6 and 12 months. Aim 5 (exploratory): To determine predictors of hospitalization, low physical activity and predictors of the change in physical activity, self efficacy and health status. Identifying predictors will allow stronger interventions and attention to those patients with higher risk for inactivity or re-hospitalizations. Predictors of change will identify patients with higher chance to respond to similar interventions (higher change over time in study outcomes).