Optimizing Osteoarthritis Care through Clinical and Community Partnership

通过临床和社区合作优化骨关节炎护理

• 批准号: 10360820
• 负责人: Kelli D. Allen
• 金额: $ 27.37万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-12-15 至 2023-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10360820
• 关键词: Address; Adult; Affect; Arthritis; Behavioral; Body Weight; Body Weight decreased; Caring; Clinic Visits; Clinical; Clinical Trials; Collaborations; Country; Data; Degenerative polyarthritis; Development; Disease; Effectiveness; Enrollment; Exercise; Goals; Guidelines; Health Personnel; Health system; Healthcare Systems; Hip Osteoarthritis; Human Resources; Individual; Infrastructure; International; Intervention; Knee; Knee Osteoarthritis; Life Style; Logistics; Measures; Modeling; Obesity; Outcome; Outcome Assessment; Overweight; Pain; Participant; Patient Care; Patients; Persons; Physical Function; Physical activity; Physical therapy; Prevalence; Primary Health Care; Progress Reports; Quality of Care; Randomized; Randomized Controlled Trials; Recommendation; Rehabilitation therapy; Reporting; Research; Services; Site; Sleep; Standardization; Statistical Data Interpretation; Structure; Testing; Time; Visit; Weight maintenance regimen; Western Ontario and McMaster Universities Arthritis Index; acceptability and feasibility; base; care providers; care systems; community clinic; community organizations; community partnership; cost; design; disability; evidence base; exercise program; exercise rehabilitation; experience; follow up assessment; follow-up; health care settings; improved; indexing; innovation; interest; meetings; nutrition; payment; personalized approach; practical application; primary outcome; programs; psychologic; recruit; response; screening; secondary outcome; service utilization; treatment guidelines; usual care arm

Many studies have documented deficiencies in quality of care for knee and hip osteoarthritis (OA), particularly with respect to lifestyle (e.g., weight management and exercise) and rehabilitative components, which are “strongly recommended,” first-line treatments. Primary drivers of these deficiencies in care are the lack of standardized models for OA management and the limited time available during routine clinic visits to address non-pharmacological aspects of OA care. The long-term goal of our research is to conduct a rigorous, multi- site randomized controlled trial (RCT) of a guideline-concordant OA care model, built on clinic-community partnership and designed for widespread implementation and sustainability in the U.S. The OA Clinic- Community CARE Model (OA CARE) will address all recommended components of knee / hip OA care, include interventions for both patients and primary care providers (PCPs), and utilize a tailored approach that efficiently matches treatments with patients’ needs. The patient component of OA CARE will include evidence- based weight management and exercise programs for all participants (delivered through the YMCA), as well as tailored referrals to physical therapy, additional weight management or nutrition services, sleep-related services and psychological services. The PCP component of OA CARE will include a video-based summary of current OA treatment guidelines (with emphasis on practical application), collaboration on patients’ referrals to specific services described above, and progress reports on enrolled patients. This exploratory clinical trial will achieve critical steps toward conducting a multi-site RCT of OA CARE. We will enroll 60 patients with symptomatic knee or hip OA and overweight / obesity who are not currently meeting physical activity recommendations. Participants will be randomized to OA CARE or a usual care control group. We will accomplish the following specific aims: Aim 1. Assess the feasibility and acceptability of OA CARE. Feasibility metrics will include recruitment rate, completion rates for weight loss and exercise program visits to the YMCA, utilization of tailored services and proportion of participants completing follow-up assessments. Acceptability of OA CARE will be evaluated from both patient and PCP perspectives. Aim 2. Obtain preliminary data on the efficacy of OA CARE with respect to the primary outcome of change in total Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score. The WOMAC will be administered at baseline, 6- months and 12-months, along with secondary outcomes including body weight, physical activity, physical function, sleep and psychological measures. Outcomes will be statistically analyzed between groups across the follow-up time points using general linear mixed models.

许多研究都记录了膝关节和髋关节骨关节炎 (OA) 护理质量的缺陷，特别是 关于生活方式（例如体重管理和锻炼）和康复组成部分， “强烈推荐”一线治疗。造成这些护理缺陷的主要原因是缺乏 OA 管理的标准化模型以及日常就诊期间可用的有限时间来解决 OA 护理的非药理学方面。我们研究的长期目标是进行严格的、多方面的研究 基于临床社区的符合指南的 OA 护理模式的现场随机对照试验 (RCT) 合作伙伴关系，旨在在美国广泛实施和可持续发展。 OA Clinic- 社区护理模式 (OA CARE) 将解决膝关节/髋关节 OA 护理的所有推荐组成部分， 包括针对患者和初级保健提供者 (PCP) 的干预措施，并采用量身定制的方法 有效地将治疗与患者的需求相匹配。 OA CARE 的患者部分将包括证据- 为所有参与者提供基于体重管理和锻炼的计划（通过 YMCA 提供），以及 量身定制的物理治疗转介、额外的体重管理或营养服务、睡眠相关服务 服务和心理服务。 OA CARE 的 PCP 部分将包括基于视频的摘要 现行 OA 治疗指南（强调实际应用）、患者转诊合作 上述具体服务以及登记患者的进度报告。这项探索性临床试验将 实现进行 OA CARE 多站点 RCT 的关键步骤。我们将招募 60 名患者 有症状的膝关节或髋关节骨关节炎以及超重/肥胖且目前无法进行体力活动 建议。参与者将被随机分配到 OA CARE 组或常规护理对照组。我们将 完成以下具体目标： 目标 1. 评估 OA CARE 的可行性和可接受性。 可行性指标将包括招募率、减肥完成率和锻炼计划访问次数 YMCA、定制服务的利用以及完成后续评估的参与者比例。 OA CARE 的可接受性将从患者和 PCP 的角度进行评估。目标 2. 获得初步结果 关于 OA CARE 对西安大略省总体变化主要结果的功效的数据 麦克马斯特大学骨关节炎指数 (WOMAC) 评分。 WOMAC 将在基线、6- 个月和 12 个月，以及次要结果，包括体重、体力活动、身体状况 功能、睡眠和心理测量。将在各组之间对结果进行统计分析 使用一般线性混合模型的后续时间点。