Enhancing cardiac and pulmonary rehabilitation adherence through home-based rehabilitation and behavioral nudges: ERA Nudge

项目摘要 我们的总体目标是增加心肺疾病的入组率、依从性和完成率。 康复（CR/PR）在低社会经济地位的多样化人群中;因此，我们将使用多管齐下的 增加转诊、入组、依从性和完成率的方法。我们的目标是：（1）实施 以电子病历为基础的方法，以增加转诊到CR/PR，2）评估选择医院或家庭为基础的效果 康复对入组、依从性和完成的影响，以及3）评估轻推消息对 坚持和完成。这项单中心试验将在丹佛健康医疗中心进行，这是一个大型的 城市综合安全网保健系统。我们将为所有患者提供手机应用程序， Movn将用于在患者中提供基于家庭的康复和轻推消息 随机分配到这些手臂。 在第一年（R61阶段），我们将1）实施基于EHR的干预措施，2）进行一系列N/1试验， 完善推动信息，并针对不同受众（包括西班牙语受众）调整干预措施 病人，和3）开发一个单页的工具，以目前的信息，利弊医院和家庭为基础的 为那些随机选择的人提供康复服务。我们将让患者、提供者和卫生管理人员参与进来， 对信息和信息表提供反馈，并让他们参与日常反馈 在研究过程中，帮助解决执行的潜在障碍，并帮助确保可持续性。在 第1年下半年，我们将开始入组II期随机试验。 在第2-5年（R33期），在符合CR或PR条件的患者中，我们将进行患者水平2x2 比较：1）基于医院的CR/PR和Movn单药治疗; 2）基于医院的CR/PR和Movn 3）选择医院或家庭CR/PR和Movn单独使用;以及4）选择 医院或基于家庭CR/PR和Movn，并带有轻推消息。主要结果将是入组， 本研究还将使用RE-AIM框架进行评价。

PROJECT SUMMARY Our overarching goal is to increase enrollment, adherence and completion of cardiac and pulmonary rehabilitation (CR/PR) in a diverse population of low socioeconomic status; thus we will use a multi-pronged approach to increase referral, enrollment, adherence and completion. Our objectives are to 1) implement an EHR-based approach to increase referral to CR/PR, 2) evaluate the effect of choice of hospital or home-based rehabilitation on enrollment, adherence and completion and 3) evaluate the effect of nudge messaging on adherence and completion. This single site trial will be performed at Denver Health Medical Center, a large urban integrated safety net health system. We will provide all patients with the cellphone-based application, Movn, which will be used to deliver home-based rehabilitation and nudge messaging among patients randomized to those arms. In year 1 (R61 phase), we will 1) implement EHR-based interventions, 2) conduct a series of N of 1 trials to refine the nudge messages and tailor the interventions for diverse audiences, including Spanish-speaking patients, and 3) develop a one-page tool to present information, pros and cons of hospital and home-based rehabilitation for those randomized to choice. We will engage patients, providers, and health administrators to provide feedback on the messages and the information sheet, as well as engaging them in routine feedback during the study to help address potential barriers to implementation and help ensure sustainability. In the latter half of year 1, we will begin enrollment in the Phase II randomized trial. In years 2-5 (R33 phase), among patients eligible for CR or PR, we will conduct a patient level 2x2 randomized trial comparing: 1) hospital-based CR/PR and Movn alone; 2) hospital-based CR/PR and Movn with nudge messaging; 3) choice of hospital or home-based CR/PR and Movn alone; and 4) choice of hospital or home-based CR/PR and Movn with nudge messaging. The primary outcomes will be enrollment, adherence and completion of CR/PR. The study will also be evaluated using the RE-AIM framework.