Identifying Effective Strategies to Improve Participation in Cardiac Rehabilitation after an Acute Cardiac Hospitalization

确定有效策略以提高急性心脏病住院后心脏康复的参与度

• 批准号: 9980205
• 负责人: Quinn Russell Pack
• 金额: $ 16.38万
• 依托单位: BAYSTATE MEDICAL CENTER, INC.
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-07-15 至 2022-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9980205
• 关键词: Acute; Acute myocardial infarction; Appointments and Schedules; Award; Biometry; Bundling; Cardiac; Cardiac Surgery procedures; Cardiac rehabilitation; Cardiology; Cardiovascular system; Caring; Case Mixes; Chronic; Clinical; Communities; Comparative Effectiveness Research; Controlled Clinical Trials; Data; Education; Effectiveness; Ensure; Event; Exercise; Faculty; Funding; Future; Goals; Guidelines; Health; Health Benefit; Heart Diseases; Hospitalization; Hospitals; Inpatients; Interview; Investigation; Knowledge; Life Style; Massachusetts; Master' s Degree; Medical center; Medicare; Medicare claim; Mentored Patient-Oriented Research Career Development Award; Mentors; Mentorship; Meta-Analysis; Outpatients; Patients; Peer Group; Personal Satisfaction; Physicians; Play; Prevention program; Preventive; Process; Qualitative Methods; Qualitative Research; Quality of Care; Quality of life; Questionnaires; Randomized Controlled Trials; Recommendation; Records; Rehabilitation therapy; Research; Research Project Grants; Research Proposals; Resources; Risk; Risk Factors; Role; Scientist; Secondary Prevention; Societies; Standardization; Statistical Data Interpretation; Statistical Models; Surveys; Testing; Time; Training; Universities; Variant; Work; base; beneficiary; cardiovascular health; career; clinical practice; contextual factors; cost effective; exercise training; experience; high risk; hospital readmission; implementation science; improved; indexing; informant; interest; medical schools; model design; multi-component intervention; percutaneous coronary intervention; prevent; professor; programs; recruit

PROJECT SUMMARY This is a resubmission for a K23 award for Quinn Pack, MD, MSc, a board-certified cardiologist and Assistant Professor at the Tufts University School of Medicine (TUSM). Dr. Pack is based in the Center for Quality of Care Research (CQCR) at Baystate Medical Center (BMC) in Springfield, Massachusetts. Dr. Pack's focus is on increasing participation rates in cardiac rehabilitation (CR) for eligible patients after an acute cardiac hospitalization. His long-term goal is to become an independent cardiovascular implementation physician-scientist. His immediate goals are to obtain a mentored research grant, successfully complete his specific aims, and obtain additional training in dissemination and implementation from the University of Massachusetts Medical School (UMMS). His prior training as a cardiologist and preventive cardiologist, as well as his Master's Degree and Tufts KL2 award, will help him to accomplish these goals. Dr. Pack has assembled a mentorship team with expertise in the proposed work and in helping junior faculty transition to independence. His Primary Mentor is Dr. Peter Lindenauer, a nationally recognized expert in the field of comparative effectiveness research and implementation science. His Co-Mentors include Dr. Phillip Ades (CR expert), Dr. Kathleen Mazor (psychometrician), and Dr. Penelope Pekow (biostatistician). Dr. Pack will have full access to the resources of BMC, TUSM, and UMMS. The CQCR (directed by Dr. Lindenauer) will provide mentoring, biostatistical, and administrative support as well as a peer group of junior faculty with similar interests. The research proposal aims to answer the question: “What are the factors and strategies that enable hospitals to achieve high risk-adjusted outpatient CR participation rates?” Despite powerful health benefits and strong society guideline recommendations for patients to attend CR after an acute cardiac hospitalization, nationally, as few as 20% of patients ever participate in CR. Because the vast majority of clinical events that qualify a patient for CR result in hospitalization, a logical place to encourage CR participation is during the patient's hospitalization. However, little is known about how hospital processes of care influence CR participation after hospital discharge. In Aim 1, using data from hospitalized Medicare beneficiaries, we will compute hospital-specific risk-standardized rates of CR to evaluate the role that hospitals play in facilitating CR participation. In the second Aim, we will perform a national survey of hospitals to identify the contextual factors and strategies associated with higher risk-standardized rates of CR participation. In Aim 3, we will use qualitative methods at high performing hospitals to explore the strategies and implementation factors that help these hospitals effectively promote CR participation. These projects will generate the knowledge and data needed for a future R01, in which we plan to conduct a randomized controlled trial to test a multifaceted intervention in order to increase rates of participation in CR following hospital discharge.

项目总结 这是Quinn Pack，MD，MSc的K23奖项的重新提交，他是董事会认证的心脏病专家和 塔夫茨大学医学院(TUSM)助理教授。帕克博士的总部设在 马萨诸塞州斯普林菲尔德贝州医疗中心(BMC)的医疗质量研究(CQCR)。帕克医生的 重点是提高符合条件的患者在急性心脏康复(CR)后的参与率 心脏住院治疗。他的长期目标是成为一名独立的心血管执行者 医生兼科学家。他的近期目标是获得一笔有指导的研究经费，顺利完成他的 具体目标，并从哥伦比亚大学获得传播和实施方面的额外培训 马萨诸塞州医学院。他之前接受过心脏病专家和预防心脏病专家的培训 作为他的硕士学位和塔夫茨KL2奖，将帮助他实现这些目标。帕克博士已经组装好了 一个导师团队，在拟议的工作和帮助初级教师过渡到独立方面具有专业知识。 他的主要导师是彼得·林德诺博士，他是国家公认的比较领域的专家 有效性研究和实施学。他的共同导师包括Phillip Ades博士(CR专家)、Dr Phillip Ades博士、 凯瑟琳·马佐(心理测量学家)和佩内洛普·佩科博士(生物统计学家)。Pack博士将拥有完全访问 BMC、TUSM和UMMS的资源。CQCR(由Lindenauer博士指导)将提供指导， 生物统计学和行政支持，以及具有相似兴趣的初级教员的同龄人小组。 该研究提案旨在回答这样一个问题：“哪些因素和策略能够使 医院要实现高风险调整后的门诊CR参与率吗？尽管有强大的健康益处和 强烈的社会指南建议患者在急性心脏住院后接受CR， 在全国范围内，只有20%的患者曾经参与过CR。因为绝大多数的临床事件 使患者有资格获得CR结果住院，鼓励CR参与的合乎逻辑的地方是在 病人的住院情况。然而，人们对医院的护理流程如何影响CR知之甚少 出院后参与。在目标1中，使用住院的医疗保险受益人的数据，我们将 计算医院特定的CR风险标化率，以评估医院在促进CR方面所起的作用 参与。在第二个目标中，我们将对医院进行全国调查，以确定背景因素 以及与较高的CR参与率相关的风险标准化策略。在目标3中，我们将使用 在高绩效医院采用定性方法，探索有助于战略和实施因素 这些医院有效地促进了CR参与。这些项目将产生知识和数据 在未来的R01中，我们计划进行一项随机对照试验，以测试多方面的 干预措施，以提高出院后CR的参与率。

项目成果

Frequency of Hazardous and Binge Drinking Alcohol Among Hospitalized Cardiovascular Patients.

• DOI: 10.1016/j.amjcard.2021.05.026
• 发表时间: 2021-08-15
• 期刊: The American journal of cardiology
• 作者: Gobeil K;Medling T;Tavares P;Sawalha K;Abozenah M;Friedmann PD;Naimi T;Pack QR
• 通讯作者: Pack QR

"I Just Wanted Nothing More Than to Get in a Real Shower": Patient Experience of the Inpatient Wait for a Heart Transplant.

“我只想洗个真正的淋浴”：住院等待心脏移植的患者经历。

• DOI: 10.1016/j.cardfail.2023.05.020
• 发表时间: 2023
• 期刊: Journal of cardiac failure
• 影响因子: 6
• 作者: Salerno,Colby;Pack,QuinnR;Jurkowski,Briana;McAnally,Kyle;Dejong,Christene;Ahmad,FarazS;Lagu,Tara
• 通讯作者: Lagu,Tara

Relation of Patient's Opinion of Alcohol's Health Effects and Drinking Habits Among Hospitalized Patients With Cardiovascular Disease.

• DOI: 10.1016/j.amjcard.2022.06.033
• 发表时间: 2022-09-15
• 期刊: AMERICAN JOURNAL OF CARDIOLOGY
• 影响因子: 2.8
• 作者: Medling, Theodore;Gobeil, Kyle;Sawalha, Khalid;Abozenah, Mohammed;Tavares, Paolo;Friedmann, Peter;Naimi, Timothy;Pack, Quinn
• 通讯作者: Pack, Quinn

Relation of a Maximal Exercise Test to Change in Exercise Tolerance During Cardiac Rehabilitation.

• DOI: 10.1016/j.amjcard.2022.04.009
• 发表时间: 2022-07-15
• 期刊: AMERICAN JOURNAL OF CARDIOLOGY
• 影响因子: 2.8
• 作者: Brawner, Clinton A.;Pack, Quinn;Berry, Robert;Kerrigan, Dennis J.;Ehrman, Jonathan K.;Keteyian, Steven J.
• 通讯作者: Keteyian, Steven J.

Incidence and Patterns of Falls in Cardiac Rehabilitation.

心脏康复中跌倒的发生率和模式。

• DOI: 10.1097/hcr.0000000000000747
• 发表时间: 2023
• 期刊: Journal of cardiopulmonary rehabilitation and prevention
• 影响因子: 3.8
• 作者: Naser,Maryam;Schilling,Patrick;Szalai,Heidi;Visintainer,Paul;Pack,Quinn
• 通讯作者: Pack,Quinn