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

 描述(由申请人提供)： 背景：心血管疾病(CVD)是导致退伍军人死亡的主要原因，而次优危险因素控制是CVD持续流行的重要机制。尽管基于临床的规划包括护士护理管理、药房支持、电话护理项目和密集的质量改进努力，但退伍军人中的心血管疾病风险因素仍然处于次优控制状态。鉴于退伍军人事务部内心血管疾病的高流行率和高成本，需要具有成本效益的机制来管理普遍存在的心血管疾病风险因素的负担。经验丰富的同伴健康教练可能是一种这样的机制；然而，以前的工作提供了有限的数据，这种模式具有VHA初级保健。先前在非VHA人群中进行的同伴支持研究报告称，在高血压控制和降低心血管风险方面有显著改善。目的：这个拟议的项目将测试Vet-Coach(老兵同行教练优化和促进心脏健康)的有效性，这是一个帮助降低退伍军人心血管疾病风险的同伴健康教练计划。本研究的总体目标是通过一项混合型1型实施研究，测试家访同伴健康教练干预的有效性，以促进具有多种心血管疾病危险因素的退伍军人的健康行为改变。为了针对高危人群，我们将重点关注高血压控制不佳和至少有一个其他心血管疾病危险因素的退伍军人。方法：我们将进行一项随机对照试验，招募n=590名退伍军人，比较包括家访、电话支持以及与适当的社区和诊所资源的联系在内的同伴健康教练干预与通常的VHA初级保健相比。主要结果是从基线到随访1年时的收缩压降低。次要结果包括弗雷明翰心血管风险评分、个人心血管风险(烟草使用、血脂)、与健康相关的生活质量和健康CAE使用。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，服药依从性、体力活动、营养、饮酒和压力管理)。此外，我们将评估干预的成本，以便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者。对退伍军人医疗保健的影响：将同伴健康教练整合到PACT初级保健团队中可能会提高退伍军人管理局向退伍军人提供社区外联的能力。鉴于退伍军人中普遍存在可改变的风险，降低心血管疾病风险提供了一个理想的干预目标。拟议的研究将增加对伙伴支持在PACT团队中的利用的了解。如果这项研究证明了主要假设，这种基于证据的支持模式可以在患有其他慢性病的退伍军人中得到更广泛的测试，以改善健康结果。

 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.