Behavioral Activation Delivered via Home-based Telehealth to Improve Functioning in Cardiovascular Disease Patients Recently Discharged from Inpatient Care

通过家庭远程医疗提供行为激活，以改善最近出院的心血管疾病患者的功能

• 批准号: 10312861
• 负责人: Ronald E. Acierno
• 金额: --
• 依托单位: RALPH H JOHNSON VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-07-01 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10312861
• 关键词: Adult; Aftercare; Age; American; Anxiety; Behavioral; Cardiovascular Diseases; Caring; Centers for Disease Control and Prevention (U.S.); Clinic; Complement; Cost Savings; Crossover Design; Data; Depressed mood; Effectiveness; Elderly; Event; Evidence based treatment; Face; Home; Hospitalization; Hospitals; Infrastructure; Intervention; Measures; Mental Depression; Modeling; Moods; Morbidity - disease rate; Outcome; Patients; Phase; Preventive measure; Provider; Psychotherapy; Quality of life; Race; Randomized Clinical Trials; Recovery; Regimen; Research; Risk; Role; Secondary to; Subgroup; Testing; Time; Travel; Veterans; Visit; actigraphy; base; comparative effectiveness; compare effectiveness; comparison group; cost; emotional symptom; evidence base; experience; follow-up; functional disability; global health; hospital readmission; improved; improved functioning; innovation; inpatient service; mortality; programs; resilience; sex; standard care; standardize measure; telehealth; treatment group

Background and Significance: Following hospital discharge, risk of depression is significantly increased in cardio-vascular disease (CVD) patients. Moreover, CVD patients with depression face reduced functioning, increased morbidity and mortality, and diminished quality of life. Unfortunately, most depressed CVD patients do not receive appropriate evidence-based care for their depression, often because they are unable to, or fearful of travelling to providers for the regimen of 8-12 weekly visits of evidence-based psychotherapy such as Behavioral Activation (BA). Our group developed, evaluated and subsequently implemented in VA clinics, the first VA program to use home based telehealth to deliver BA for depression to elderly Veterans. We now propose to evaluate the ability of this evidence based treatment and delivery model (BA for depression via home- telehealth) to reduce functional impairment and improve recovery in depressed Veterans who have experienced a CVD event-related hospitalization. Research Plan and Specific Aims: 1. To compare effectiveness of Behavioral Activation for depression delivered via Home-based Telehealth- to standard post-CVD hospital discharge best-practices care in a 2x4 (treatment by time) repeated measures RCT crossover design (baseline, post-treatment, 3 & 9-month follow-up; crossover for standard treatment group at 9 months) with 132 CVD Veteran patients evincing depression in terms of central outcomes of functioning (PROMIS Functioning and Global Health scales) and emotional symptoms (PROMIS Depression and Anxiety scales) and secondary objective outcomes related to activity (actigraphy data). At the 9 month point, the comparison group will have the option of receiving the intervention (thus complementing the RCT with a crossover phase). 2. To repeat these comparisons with sex and age as independent variables. 3. To evaluate BA-HT with respect to its effects on exploratory outcomes, including re-hospitalization. Hypotheses: We predict that evidence-based psychotherapy for depression (i.e., Behavioral Activation) delivered via home based telehealth will more effectively increase social role and activity functioning, activity, mood and reduce 6-month re-hospitalization (exploratory hypothesis), compared to current best-practices post-discharge care among patients scoring at least moderately depressed on the PROMIS Depression scale one week following hospital discharge for a CVD event. Impact: If effective, this innovative treatment and delivery strategy will enhance global functioning, improve quality of life, and reduce costs to Veterans and the VA. Importantly, the proposed strategy leverages existing VA infrastructure and capabilities so that BA-HT could be immediately offered throughout VA as a preventative measure to enhance resiliency.

背景和意义： 出院后，心血管疾病患抑郁症的风险显著增加。 (CVD)患者。此外，患有抑郁症的心血管疾病患者面临功能减退、发病率增加和 死亡率和生活质量下降。不幸的是，大多数抑郁的CVD患者没有 为他们的抑郁症提供适当的循证护理，通常是因为他们不能或害怕旅行 提供每周8-12次的循证心理治疗，如行为疗法 激活(BA)。我们团队开发、评估并随后在退伍军人管理局诊所实施了第一个退伍军人管理局 计划使用基于家庭的远程健康，为老年退伍军人提供治疗抑郁症的BA。我们现在建议 评估这种循证治疗和交付模式(BA)通过家庭治疗抑郁症的能力 远程医疗)，以减少功能损害并改善患有抑郁症的退伍军人的康复 经历了一次心血管事件相关的住院治疗。 研究计划和具体目标： 1.行为激活治疗抑郁症的效果比较 远程健康-到标准的CVD后出院最佳实践护理2x4(按时间治疗)重复 测量随机对照试验交叉设计(基线、治疗后、3个月和9个月的随访；标准交叉 治疗组9个月)，132名心血管疾病退伍军人患者在中枢结局方面表现出抑郁 功能(Promis功能和全球健康量表)和情绪症状(Promis抑郁症 和焦虑量表)和与活动有关的次要目标结果(活动记录数据)。在9个月时 在这一点上，对照组将有权接受干预(从而补充随机对照试验 具有交叉阶段)。 2.以性别和年龄为自变量，重复这些比较。 3.评估BA-HT对探查结果的影响，包括再次住院。 假设： 我们预测，以证据为基础的抑郁症心理治疗(即行为激活)通过 基于家庭的远程健康将更有效地提高社会角色和活动功能、活动、情绪和 与目前出院后的最佳做法相比，减少6个月的再次住院(探索性假设) 普鲁米斯抑郁量表在一周内至少获得中度抑郁的患者的护理 在因心血管疾病事件出院后。 影响： 如果有效，这一创新的治疗和提供战略将增强全球功能，改善 生活质量，并降低退伍军人和退伍军人的成本。重要的是，拟议的战略利用了现有的 VA基础设施和功能，以便BA-HT可以立即在整个VA作为预防措施提供 提高复原力的措施。