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

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。心脏康复（CR），多学科结构化二级 采用有效的生活方式疗法来降低继发性心脏事件风险的预防计划， 改善功能状态，已证明HF患者的结局改善，射血减少 分数（HFrEF）。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 对HFrEF患者的CR进行报销。然而，国家数据表明，只有2%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。 我们的长期目标是改善HF患者的健康和预后。家长的目标 该提案旨在确定提高HF患者CR参与率的实施策略。我们 正在努力完成母公司提案目标1（分析最近住院的医疗保险索赔 HF患者）和目标2（进行定性访谈，以确定CR的促进因素和障碍 参与和执行战略）。然后，在目标3中，我们将向一个小组介绍我们的研究结果， 将优先考虑战略的利益攸关方。目标4是在公司责任实践的一个子集中试点选定的战略， 然后制定建议，以增加HF患者的CR实施。当我们开始 准备德尔菲小组，将优先考虑的战略，我们意识到，障碍CR HF和战略 这些障碍是紧密相连的。这对目标4有影响：试点地点将难以选择 如果他们没有在他们的项目中识别出CR的当地障碍，所以我们 提出四个补充目标，以确保目标4的成功。这些目标将由一位杰出的 一位学士后研究员（亚历克西斯·斯图尔特）也是一个代表性不足的少数群体的成员。 在导师和整个研究团队的支持下，她将：1）确定试点的具体障碍， HF患者的转诊、入组和参与; 2）协助试点研究中心配对已确定的 实施战略，以具体地点的障碍; 3）促进建立一个学习社区， 试点地点在将实施战略付诸实践时相互支持; 4）收集定性信息， 对目标4中试行的战略的可接受性和适当性的反馈。这些目标将有助于女士。 斯图尔特成为一个有竞争力的博士申请人，并最终成为独立研究员。他们也是 符合国家心脏，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”。

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. Cardiac rehabilitation (CR), a multidisciplinary structured secondary prevention program that applies effective lifestyle therapies to reduce the risk of secondary cardiac events and improve functional status, has demonstrated improved outcomes in patients with HF and reduced ejection fraction (HFrEF). 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 reimburse CR for patients with HFrEF. However, national data suggest that only 2% 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 improve the health and outcomes of patients with HF. The objective of the parent proposal is to identify implementation strategies that increase participation in CR among patients with HF. We are working to complete parent proposal Aim 1 (analysis of Medicare claims among recently hospitalized patients with HF) and Aim 2 (to conduct qualitative interviews to identify facilitators and barriers to CR participation and implementation strategies). We will then, in Aim 3, present our findings to a panel of stakeholders who will prioritize strategies. Aim 4 is a pilot of selected strategies in a subset of CR practices and then development of recommendations to increase implementation of CR in patients with HF. As we began to prepare for the Delphi panel that will prioritize strategies, we realized that barriers to CR for HF and strategies to address those barriers are tightly linked. This has implications for Aim 4: pilot sites will struggle to choose from possible strategies if they do not identify the local barriers to CR within their program. Therefore, we propose four supplemental aims to ensure the success of Aim 4. These aims will be led by an outstanding post-baccalaureate researcher (Alexis Stewart) who is also a member of an under-represented minority group. With support from her mentors and the entire study team, she will: 1) Identify pilot site-specific barriers to referral, enrollment, and participation among patients with HF; 2) Assist pilot sites in pairing the list of identified implementation strategies to site-specific barriers; 3) Facilitate creation of a learning community that allows pilot sites to support each other as they put implementation strategies into practice; 4) Collect qualitative feedback on the acceptability and appropriateness of strategies piloted in Aim 4. These aims will help Ms. Stewart to become a competitive PhD applicant and, eventually, independent researcher. 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.”