A mixed methods study to identify and refine implementation strategies to increase use of cardiac rehabilitation for patients with heart failure

一项混合方法研究，旨在确定和完善实施策略，以增加心力衰竭患者心脏康复的使用

• 批准号: 9916799
• 负责人: Tara C Lagu
• 金额: $ 65.7万
• 依托单位: BAYSTATE MEDICAL CENTER, INC.
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-05-01 至 2020-10-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9916799
• 关键词: Accounting; Acute Coronary Event; Adult; Advocate; Aerobic; Affect; American; American Heart Association; Body Weight decreased; Cardiac; Cardiac rehabilitation; Cardiology; Cardiovascular system; Chronic Disease; Clinical; Clinical Practice Guideline; Clinical Research; Collaborations; Communities; Coronary Artery Bypass; Counseling; Data; Development; Diagnosis; Disease; EFRAC; Ecosystem; Education; Ensure; Event; Evidence based intervention; Exercise Tolerance; Feedback; Future; Goals; Health; Health system; Heart failure; Hospital Referrals; Hospitalization; Hospitals; Impairment; Influentials; Inpatients; Intervention; Interview; Investigation; Lead; Lifestyle Therapy; Maps; Medicare; Medicare claim; Methods; National Heart, Lung, and Blood Institute; Outpatients; Patient Education; Patient Participation Rates; Patient Self-Report; Patient advocacy; Patient-Focused Outcomes; Patients; Play; Policies; Population; Practice Guidelines; Prevention program; Qualitative Methods; Quality of life; Recommendation; Records; Reporting; Research; Risk; Risk Factors; Role; Secondary Prevention; Self Care; Standardization; Statistical Data Interpretation; Structure; System; Time; Translational Research; United States Centers for Medicare and Medicaid Services; Variant; acute coronary syndrome; advocacy organizations; base; beneficiary; college; comorbidity; contextual factors; deviant; diet and exercise; exercise training; functional status; hospital readmission; implementation research; implementation strategy; implementation trial; improved; improved outcome; mortality; multidisciplinary; preservation; programs; pulmonary rehabilitation; randomized controlled study; readmission rates; recruit; smoking cessation; stress reduction; symptomatic improvement

PROJECT SUMMARY More than 6.5 million American adults have HF, which results in approximately 1 million hospital admissions per year in patients 65 year and older. Hospitalized patients with HF have a 30-day mortality rate of approximately 10%. Cardiac rehabilitation (CR), a multidisciplinary structured secondary prevention program that applies effective lifestyle therapies (diet, exercise, stress reduction, smoking cessation, weight loss, etc.) to reduce the risk of secondary cardiac events and improve functional status, has demonstrated a modest reduction in all-cause mortality in patients with HF and reduced ejection fraction (HFrEF). Randomized controlled studies of patients with HFrEF or HF with preserved ejection fraction have reported that CR improves symptoms, increases aerobic capacity, endurance, improves self-reported quality of life, and reduces rehospitalization. The American Heart Association and the American College of Cardiology recommend exercise training for patients with HF, and, in 2014, the Centers for Medicare and Medicaid Services began to cover CR for patients with HFrEF. However, national data suggest that only 2-10% of patients with HF attend CR after a hospitalization and our preliminary data suggest that little improvement has occurred since 2014. Our long-term goal is to identify effective delivery-system interventions that improve the health and outcomes of patients with HF. The objective of this proposal is to identify implementation strategies that increase participation in CR among patients with HF. Then with a group of clinicians, patient advocacy organizations, CR leaders, policymakers, and payers, we will prioritize strategies that are the most acceptable, feasible, and responsive to the needs of the community. In Aim 1, we will analyze Medicare claims among recently hospitalized HF patients to identify hospital-referral regions (HRRs) that are most and least successful in recruiting recently hospitalized patients with HF to CR. Beginning with these programs, we will use the Consolidated Framework for Implementation Research (CFIR) to guide qualitative interviews of clinicians with these HRRs, identifying facilitators and barriers to CR participation. We will present our findings to a panel of stakeholders who will prioritize strategies. We will then pilot these strategies in a subset of CR practices in order to refine the final set of recommendations that will inform practice (e.g., outpatient and inpatient clinicians, CR programs, patients), policy (e.g., clinical practice guidelines and reimbursement strategies), and future research (e.g., implementation trials). These activities are highly responsive to the STIMULATE RFA because they are timely, engage a range of stakeholders, and examine implementation of an underutilized evidence-based intervention. They are also consistent with National Heart, Lung, and Blood Institute's Strategic Goals and Objectives, specifically objective 6, which aims to “optimize translational, clinical, and implementation research to improve health and reduce disease.”

项目摘要 超过650万美国成年人患有HF，导致约100万人住院 65岁及以上患者。HF住院患者的30天死亡率为 大约10%。心脏康复（CR），多学科结构化二级预防计划 应用有效的生活方式疗法（饮食，运动，减压，戒烟，减肥等） 降低继发性心脏事件的风险并改善功能状态，已证明适度 降低HF和射血分数降低（HFrEF）患者的全因死亡率。随机 射血分数保留的HFrEF或HF患者的对照研究报告称，CR 改善症状，增加有氧能力，耐力，改善自我报告的生活质量， 再次住院美国心脏协会和美国心脏病学会建议 HF患者的运动训练，2014年，医疗保险和医疗补助服务中心开始 覆盖HFrEF患者的CR。然而，国家数据表明，只有2-10%的HF患者参加 住院后CR，我们的初步数据表明自2014年以来几乎没有改善。 我们的长期目标是确定有效的交付系统干预措施，改善健康和结果 HF患者。本提案的目标是确定实施战略，以增加 参与HF患者的CR。然后和一群临床医生，病人权益组织， CR领导者，政策制定者和支付者，我们将优先考虑最可接受，最可行， 回应社会的需要。在目标1中，我们将分析最近 住院HF患者，以确定最成功和最不成功的医院转诊区域（HRR）， 招募近期住院的HF至CR患者。从这些程序开始，我们将使用 实施研究的综合框架（CFIR），以指导临床医生的定性访谈， 这些人权规则，确定公约与建议委员会参与的促进者和障碍。我们将把我们的发现提交给一个小组， 将优先考虑战略的利益攸关方。然后，我们将在公司责任实践的一个子集中试行这些战略， 为了完善最终的一套建议，将告知实践（例如，门诊和住院 临床医生、CR程序、患者），政策（例如，临床实践指南和报销策略），以及 未来的研究（例如，执行试验）。这些活动对STIMULATE RFA高度敏感 因为它们是及时的，让一系列利益相关者参与，并检查未充分利用的 循证干预。它们也与国家心脏、肺和血液研究所的 战略目标和目的，特别是目标6，旨在“优化转化、临床和 实施研究以改善健康和减少疾病。”