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: 10310735
• 负责人: Tara C Lagu
• 金额: $ 61.4万
• 依托单位: NORTHWESTERN UNIVERSITY AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-05-25 至 2024-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10310735
• 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; Consolidated Framework for Implementation Research; 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.”

项目总结