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

项目总结 我们的首要目标是增加心脏和肺科的招生、坚持和完成 在社会经济地位较低的不同人群中进行康复(CR/PR)；因此，我们将多管齐下 增加转诊、入学、遵守和结业的方法。我们的目标是1)实施 基于电子病历的方法，以增加转诊到CR/PR，2)评估选择医院或家庭的效果 关于注册、遵守和完成的康复以及3)评估轻推消息在以下方面的影响 坚持和完成。这一单点试验将在丹佛健康医疗中心进行，丹佛健康医疗中心是一家 城市综合安全网卫生体系。我们将为所有患者提供基于手机的应用程序， Movn，将用于在患者之间提供基于家庭的康复和推送消息 被随机分配到那些手臂上。 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，以 完善推送信息并针对不同受众定制干预措施，包括说西班牙语的受众 患者，以及3)开发一页工具来显示医院和家庭的信息、利弊 对于那些随机选择的康复者。我们将让患者、提供者和健康管理人员参与 就信息和信息表提供反馈，并让他们参与日常反馈 在研究期间帮助解决执行方面的潜在障碍，并帮助确保可持续性。在 第一年下半年，我们将开始登记参加第二阶段随机试验。 在第2-5年(R33阶段)，在符合CR或PR条件的患者中，我们将进行患者级别的2x2 随机试验比较：1)基于医院的CR/PR和单独的Movn；2)基于医院的CR/PR和Movn 使用轻推消息；3)选择医院或基于家庭的CR/PR和Movn；以及4)选择 医院或家庭的CR/PR和Movn，带轻推消息。主要结果将是招生， CR/PR的坚持和完成。这项研究还将使用RE-AIM框架进行评估。

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.