Video vs. TTG Respiratory inhaler technique Assessment and InstructioN (V-TRAIN)

描述（由申请人提供）：通过有效使用呼吸吸入器装置提供的治疗，可能会预防哮喘和COPD恶化的住院治疗。有效使用的一个关键限速步骤是正确的吸入器技术。临床指南建议在所有情况下评估和教授吸入器技术。住院患者群体是评估和纠正吸入器技术的一个特别突出的目标，因为住院患者预后不良的风险增加，包括再次住院。医院资源有限，患者保留医院教育的能力可能不完整，这将需要出院后教育的加强。基于这些原因，开发和测试便携式的、有效的基于医院的教育策略是必要的。在过去的几年里，我一直在建立一种面对面的“从教学到目标（TTG）”策略（轮次评估和演示，直到掌握）的有效性，以指导住院患者正确使用吸入器技术。虽然我们发现TTG比简单的口头指示更有效，但它在实施上有局限性。首先，它是资源密集型的，其次，它缺乏便携的出院后加固。因此，在本提案中，我旨在研究包括轮次自我评估和基于视频的演示在内的交互式视频模块教育（VME）是否优于面对面的TTG。VME直接对抗了TTG的局限性，因为它可能更少的资源密集，并且可用于出院后的增援。因此，我将开发VME (Aim 1a)，然后将在随机临床试验中测试VME与TTG，根据诊断进行分层，因为哮喘和COPD患者之间存在固有的不同患者和疾病特征（Aim 1b）。最后，服务不足的患者可能无法获得出院后VME。因此，我将使用医院医学数据收集基础设施进行一项观察性研究，以确定能够获得并愿意使用出院后VME的患者比例（目标2）。因此，通过这个K23职业发展奖提案，我将把我的研究经验与我的导师David Meltzer博士、联合导师Jerry Krishnan博士以及一个在阻塞性肺病、比较有效性研究、行为和教育干预领域的专家咨询团队一起，开始填补这些知识和临床实践方面的空白。我将使用这些数据

DESCRIPTION (provided by applicant): Hospitalizations for exacerbations of asthma and COPD can likely be prevented through effective use of therapies delivered through respiratory inhaler devices. One critical rate-limiting step to effective use is correct inhaler technique. Clinical guidelines recommend assessing and teaching inhaler technique in all settings. The hospitalized patient population is a particularly salient target for evaluating and correcting inhaler technique, as inpatients are at increased risk for poor outcomes, including rehospitalizations. Hospital resources are limited, and patients' ability to retain hospital-based education is likely to be incomplete, which would require post- discharge educational reinforcement. For these reasons, developing and testing portable, effective hospital- based educational strategies are warranted. I have spent the last several years establishing the effectiveness of an in-person "Teach-to-Goal [TTG]" strategy (rounds of assessment and demonstration until mastery is attained) to instruct hospitalized patients on correct inhaler technique. While we have found that TTG is more effective than simple verbal instructions, it has limitations for implementation. First, it is resource intensive and second, it lacks portabilit for post-discharge reinforcement. Therefore, in this proposal I aim to study whether interactive video-module education (VME) that includes rounds of self-assessment and video-based demonstration, is a non-inferior approach to in-person TTG. VME directly counters TTG's limitations as it is likely less resource-intensive and is portable for post-discharge reinforcemen. Therefore I will develop VME (Aim 1a) and then will test VME vs. TTG in a randomized clinical trial, stratified by diagnosis, since there are inherent different patient and disease characteristcs among patients with asthma and COPD (Aim 1b). Finally, underserved patients may not have access to post-discharge VME. I will therefore conduct an observational study using the Hospitalist Medicine Data Collection Infrastructure, to determine the proportion of patients with access to and willingness to use post-discharge VME (Aim 2). Therefore, with this K23 career development award proposal, I will bring my research experience together with my Mentor, Dr. David Meltzer, Co-Mentor, Dr. Jerry Krishnan, and an expert advisory team in the fields of obstructive lung diseases, comparative effectiveness research, and behavioral and educational interventions to begin to fill these gaps in knowledge and clinical practice. I will use these data to design an R-01 feasibility and cost-effectiveness study to determine the real-world effectiveness of VME to help transition patients from hospital to home with sufficient educational support, and to determine if clinical outcomes improve. This award would also allow me to seek additional training in advanced biostatistics, formal training in the development and assessment of educational strategies, and training in the design and implementation of complex behavioral clinical trials. These experiences will position me to become a leader in developing, evaluating and implementing high-quality interventions to improve patient self-management of obstructive lung disease to improve clinical outcomes.