Vet-COACH (Veteran peer Coaches Optimizing and Advancing Cardiac Health)

Vet-COACH（优化和促进心脏健康的资深同行教练）

• 批准号: 10805352
• 负责人: KARIN M. NELSON
• 金额: --
• 依托单位: VA PUGET SOUND HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-03-01 至 2023-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10805352
• 关键词: Adoption; Alcohol consumption; Blood Pressure; Cardiac health; Cardiovascular Diseases; Caring; Case Manager; Characteristics; Chronic; Chronic Disease; Clinic; Communities; Community Health Aides; Community Outreach; Comprehensive Health Care; Cost Analysis; Data; Diabetes Mellitus; Disease; Eating; Education; Emergency department visit; Enrollment; Future; Goals; Health; Health Benefit; Health Care Costs; Health Promotion; Health behavior; Health behavior and outcomes; Health behavior change; Health education; Health system; Healthcare; Healthcare Systems; High Prevalence; Home; Home visitation; Hospitalization; Hybrids; Hyperlipidemia; Hypertension; Individual; Intervention; Life Experience; Link; Lipids; Literature; Measures; Medical; Mental Health; Modeling; Morbidity - disease rate; Motivation; Nursing Care Management; Obesity; Outcome; Overweight; Patients; Pharmacists; Pharmacy facility; Physical activity; Population; Prevalence; Prevention program; Primary Care; Randomized; Randomized, Controlled Trials; Reporting; Resources; Risk; Risk Factors; Risk Reduction; Self Management; Services; Smoke; Social support; Telephone; Testing; Tobacco use; Training; Unhealthy Diet; United States Department of Veterans Affairs; Veterans; Work; behavior change; cardiovascular disorder risk; cardiovascular risk factor; communication behavior; community clinic; cost; cost effective; disorder prevention; effectiveness testing; evidence base; follow-up; health care service utilization; health related quality of life; healthy lifestyle; high risk population; hypertension control; implementation study; improved; intervention cost; medication compliance; modifiable risk; mortality; nutrition; patient oriented; peer; peer coaching; peer support; primary care provider; primary care team; primary outcome; programs; provider behavior; satisfaction; secondary outcome; sedentary; social; stress management

 DESCRIPTION (provided by applicant): BACKGROUND: Cardiovascular disease (CVD) is the leading cause of mortality among Veterans, and suboptimal risk factor control is an important mechanism for the continued prevalence of CVD. Despite clinic based programming that includes nurse care management, pharmacy support, telephone care programs and intensive quality improvement efforts, CVD risk factors remain sub-optimally controlled among Veterans. Given the high prevalence and cost CVD within the Department of Veterans Affairs, cost-effective mechanisms are needed to manage the burden of prevalent CVD risk factors. Veteran peer health coaches may be one such mechanism; however, previous work has provided limited data of this model with VHA primary care. Previous studies of peer support in non-VHA populations report significant improvement in hypertension control and CVD risk reduction. OBJECTIVES: The proposed project will test the effectiveness of Vet-COACH (Veteran peer Coaches Optimizing and Advancing Cardiac Health), a peer health coaching program to help reduce CVD risk among Veterans. The overall goal of this study is to test the effectiveness of a home-visit peer health coach intervention to promote health behavior change among Veterans with multiple CVD risk factors with a hybrid type 1 implementation study. To target a high risk population, we will focus on Veterans with poorly controlled hypertension and at least one other CVD risk factor. METHODS: We will conduct a randomized controlled trial that will enroll n=590 Veterans to compare a peer health coach intervention consisting of home visits, telephone support, and linkages to appropriate community-based and clinic resources compared to usual VHA primary care. The primary outcome is reduction in systolic blood pressure from baseline to follow-up at 1-year. Secondary outcomes include a reduction in Framingham Cardiovascular risk score, individual cardiovascular risks (tobacco use, lipids), health related quality of life and health cae use. We will also assess the effects of the peer health coach intervention on intermediate outcomes including social support, patient activation, patient/provider communication and health behaviors (e.g. medication adherence, physical activity, nutrition, alcohol use, and stress management). In addition, we will assess the cost of the intervention to inform feasibility for future studies, determine Veteran and staff satisfaction with the intervention, and identify barriers and facilitators to adoption. IMPACT ON VETERANS HEALTH CARE: Integrating peer health coaches into PACT primary care teams may improve the VA's ability to provide community outreach to Veterans. CVD risk reduction provides an ideal target for intervention given the prevalence of modifiable risks among Veterans. The proposed study will increase understanding of the utilization of peer support within PACT teams. If this study proves the main hypothesis, this evidence-based support model could be tested more widely among Veterans with other chronic conditions to improve health outcomes.

 描述（由申请人提供）： 背景技术背景：心血管疾病（CVD）是退伍军人死亡的主要原因，而次优风险因素控制是CVD持续流行的重要机制。尽管基于诊所的编程，包括护士护理管理，药房支持，电话护理计划和密集的质量改进工作，心血管疾病的风险因素仍然控制在退伍军人中。鉴于退伍军人事务部内CVD的高患病率和成本，需要具有成本效益的机制来管理流行的CVD风险因素的负担。经验丰富的同伴健康教练可能是这样的机制之一，但是，以前的工作提供了有限的数据，这种模式与VHA初级保健。以前的研究在非VHA人群中的同伴支持报告显着改善高血压控制和CVD风险降低。目标：拟议的项目将测试Vet-COACH（退伍军人同伴教练优化和促进心脏健康）的有效性，这是一个同伴健康教练计划，旨在帮助降低退伍军人的CVD风险。本研究的总体目标是测试家访同伴健康教练干预的有效性，以促进具有多种CVD风险因素的退伍军人的健康行为改变，并进行混合1型实施研究。针对高风险人群，我们将重点关注高血压控制不佳和至少一个其他CVD风险因素的退伍军人。方法：我们将进行一项随机对照试验，将入组n=590名退伍军人，比较同伴健康教练干预（包括家访、电话支持以及与适当的社区和诊所资源的联系）与常规VHA初级保健。主要结局是收缩压从基线到1年随访的降低。次要结局包括Fragrance心血管风险评分、个体心血管风险（烟草使用、血脂）、健康相关生活质量和健康护理使用的降低。我们还将评估同伴健康教练干预对中间结果的影响，包括社会支持，患者激活，患者/提供者沟通和健康行为（例如药物依从性，体力活动，营养，酒精使用和压力管理）。此外，我们将评估干预的成本，为未来的研究提供可行性信息，确定退伍军人和工作人员对干预的满意度，并确定采用的障碍和促进因素。对退伍军人健康护理的影响：将同伴健康教练纳入PACT初级保健团队可能会提高退伍军人管理局向退伍军人提供社区外展服务的能力。CVD风险降低提供了一个理想的干预目标，因为退伍军人中存在可改变的风险。拟议的研究将增进对PACT小组内利用同侪支助的了解。如果这项研究证明了主要假设，这种基于证据的支持模型可以在患有其他慢性病的退伍军人中进行更广泛的测试，以改善健康状况。