Prescribing Smart Aging: Integrating Health Systems with Community-Based Lifestyle Interventions

开出智慧老龄化处方：将卫生系统与基于社区的生活方式干预措施相结合

• 批准号: 9240378
• 负责人: JEFFREY Murray BURNS
• 金额: $ 59.18万
• 依托单位: UNIVERSITY OF KANSAS MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-15 至 2022-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9240378
• 关键词: Accelerometer; Adoption; Affect; Aging; Alzheimer' s Disease; American; Americas; Back; Biological Assay; Body Composition; Cholesterol; Chronic Disease; Cities; Communities; Control Groups; Data; Development; Disease; Dropout; Drops; Education; Educational Curriculum; Educational Materials; Effectiveness; Elderly; Electronic Health Record; Exercise; Fatty acid glycerol esters; Feeds; Fitness Centers; Funding; Goals; Health; Health Benefit; Health Personnel; Health behavior change; Health system; Healthcare Systems; High Density Lipoproteins; Home environment; Hospitals; Individual; Insulin Resistance; Intervention; Interview; Kansas; Life Style; Link; Lipids; Low-Density Lipoproteins; Maintenance; Manuals; Measurable; Measures; Metabolic; Monitor; Outcome; Outcome Assessment; Outcome Measure; Outcome Study; Oxygen Consumption; Participant; Patients; Pattern; Phase; Physical Exercise; Physical activity; Physicians; Physiological; Process; Quality of life; Randomized; Randomized Controlled Trials; Recruitment Activity; Resources; Risk; Risk Factors; Self Efficacy; Structure; Supervision; Surveys; System; Testing; Thinness; Training; United States National Institutes of Health; Universities; age related; aging population; base; behavior change; cardiorespiratory fitness; clinical care; cost effective; design; efficacy testing; evidence base; exercise program; exercise training; experience; feeding; fitness; healthy lifestyle; improved; innovation; interest; lifestyle intervention; mHealth; metabolic profile; moderate-to-vigorous physical activity; mortality; primary outcome; programs; response; satisfaction; secondary outcome; standard of care; tool; trial design; wearable technology

Abstract/Project Summary The health care system is insufficiently capitalizing on the benefits of physical exercise in America's aging population. Significant barriers limit older adults from initiating and maintaining exercise programs. Additionally, few effective tools exist to help clinicians incorporate physical activity into their clinical care. Here, we seek to test the effectiveness of delivering an exercise and healthy lifestyle program – Smart Aging – to physicians and their older adult patients. Smart Aging represents a multi-level partnership between the University of Kansas Hospital and the Greater Kansas City YMCA network that is scalable, broadly implementable, and sustainable in the real world. The program begins at the patient-physician level with clinician-referral of interested older adults into the Smart Aging program via an electronic prescription embedded in the electronic health record. The Smart Aging program is then conducted in the community- based YMCA, extends into the participant's home (home exercise, mobile-health monitoring) and ultimately feeds physical activity data back to the clinician (“physical activity as a vital sign”). This proposal uses a rigorous randomized controlled trial design to test if the Smart Aging program induces meaningful and sustained health benefits. Participants will be randomized (1:1 ratio) to an immediate- start vs an education-only control group. We hypothesize that the Smart Aging program will benefit our primary study outcome of cardiorespiratory fitness at both 12 and 52 weeks (aim 1) and positively affect secondary metabolic measures of insulin resistance, body composition, and lipid status (aim 2). As our goal is to create a useful physician tool, we also explore important developmental outcomes (aim 3) relevant to the scalability and implementation of the program including physician adoption rates and referral patterns, barriers to use, and perceived usefulness through surveys and interviews. We will also assess the patient experience including drop-out rates and measures of satisfaction, quality-of-life, and self-efficacy. Our ultimate goal is to create a scalable and cost-effective program for clinicians and their patients to reduce the risk of chronic disease by inducing healthy lifestyle behavior changes through this multi-level intervention. The KU Alzheimer's Disease Center and YMCA of Greater Kansas City have experience in deploying various aspects of the Smart Aging program, from the referral process to m-Health monitoring, and now seek to test its comprehensive packaging for clinicians and their patients. If shown to be effective, the program will be deployable nationally to bring together health systems with community-based fitness resources.

摘要/项目摘要 在美国，医疗保健系统没有充分利用体育锻炼的好处。 人口老龄化严重的障碍限制了老年人开始和维持锻炼计划。 此外，几乎没有有效的工具可以帮助临床医生将身体活动纳入他们的临床护理。 在这里，我们试图测试提供锻炼和健康生活方式计划的有效性-智能 老龄化-医生和他们的老年患者。智能老龄化代表了多层次的合作伙伴关系， 堪萨斯大学医院和大堪萨斯城基督教青年会网络，可扩展，广泛 在真实的世界中是可实施的和可持续的。该计划开始于病人医生的水平， 临床医生通过电子处方将感兴趣的老年人转介到智能老龄化计划中 嵌入到电子健康记录中。然后在社区开展智能老龄化计划- 基于基督教青年会，延伸到参与者的家庭（家庭锻炼，移动健康监测），并最终 将身体活动数据反馈给临床医生（“身体活动作为生命体征”）。 该提案使用严格的随机对照试验设计来测试智能老龄化计划是否 产生有意义和持续的健康益处。受试者将被随机（1：1比例）分配至即刻- 开始与仅接受教育的对照组。我们假设智能老龄化计划将使我们的 第12周和第52周的心肺适能的主要研究结果（目的1）和积极影响 胰岛素抵抗、身体组成和脂质状态的次级代谢测量（目的2）。由于我们的目标是 为了创建一个有用的医生工具，我们还探索了与以下方面相关的重要发展结果（目标3）： 该计划的可扩展性和实施情况，包括医生采用率和转诊模式， 使用，并通过调查和访谈感知有用性。我们还将评估患者的体验 包括辍学率和满意度，生活质量和自我效能的措施。 我们的最终目标是为临床医生及其患者创建一个可扩展且具有成本效益的计划， 通过这种多层次的方法， 干预KU阿尔茨海默病中心和大堪萨斯城的基督教青年会有经验， 部署智能老龄化计划的各个方面，从转诊流程到移动健康监控，以及 现在寻求测试其全面的包装，为临床医生和他们的病人。如果被证明是有效的， 该计划将在全国范围内部署，将卫生系统与社区健身结合起来 资源