Social Support, Self-Management, and Hospital Use for Heart Failure

描述（由申请人提供）：与白人相比，患有心力衰竭的老年非洲裔美国人更有可能因心力衰竭住院。然而，非裔美国人心力衰竭患者的1年死亡率与白人心力衰竭患者相似，甚至更低。先前的研究表明，出院后护理、非裔美国人心力衰竭的独特作用、合并症和获得护理等因素可能解释了医院使用的一些差异。然而，很少有研究考察非临床因素，如患者的社会支持。社会支持对于心衰的成功门诊管理至关重要，特别是在老年人中。家庭或朋友提供的社会支持可能有助于采用和坚持自我管理行为，如检查每日体重和保持低钠饮食。社会支持可能通过自我管理行为和心力衰竭住院治疗之间的中介作用降低心力衰竭发病率。本研究将包括一项前瞻性队列研究，研究对象为非裔美国人和40岁以上曾因心力衰竭住院的白人成年人1)评估社会支持与心力衰竭之间的关系2)评估自我管理行为与心力衰竭住院治疗之间的关系3)衡量社会支持在多大程度上调节自我管理行为与心力衰竭住院治疗之间的关系。研究参与者将使用单个大型教学医院的出院管理数据进行选择。在研究开始时，将使用一种带有有效量表的调查工具来测量社会支持和自我管理行为。此外，对医生的信任、合并症、功能状态、药物使用和依从性等其他数据将通过调查收集。在1年随访期结束时，行政医院数据将用于测量所有研究参与者在过去12个月内在同一所教学医院治疗心力衰竭的住院情况。在数据分析中，将使用多变量模型来检验社会支持和自我管理行为与心力衰竭住院治疗之间的独立关系。此外，序贯模型构建将用于确定社会支持是否是自我管理行为与心力衰竭住院之间关系的中介。本研究将有助于阐明这些患者因素与心力衰竭住院治疗之间的关系。此外，该研究应为未来设计基于社区的干预措施提供信息，以增加或优化社会支持，努力解决心力衰竭住院治疗中的种族差异。公共卫生相关性：心力衰竭影响美国约2.6%的成年人，是每年医疗保险受益人住院治疗的主要原因。因心力衰竭住院治疗的种族差异反映出老年非裔美国人心力衰竭的疾病负担高于白人。阐明社会支持在自我管理行为和心力衰竭住院治疗方面的作用，对于创建和实施以社区为基础的干预措施以解决这些医疗保健差异至关重要。

DESCRIPTION (provided by applicant): Elderly African Americans with heart failure are more likely to be hospitalized for heart failure compared to their white counterparts. However, African Americans with heart failure also frequently have similar or even lower 1- year mortality compared to white heart failure patients. Previous studies have shown that factors such as post-discharge care, the unique role of heart failure among African Americans, comorbidities, and access to care may account for the some of disparities in hospital use. However, fewer studies have examined non-clinical factors such as patient social support. Social support is essential to the successful outpatient management of heart failure, particularly among the elderly. Social support, provided by family or friends, may facilitate the adoption of and adherence to self-management behaviors such as checking daily weights and maintaining a low sodium diet. Social support may decrease heart failure morbidity through this mediating role in the relationship between self-management behaviors and hospital use for heart failure. The proposed research will include a prospective cohort study of African American and white adults over age 40 previously hospitalized for heart failure 1) to assess the relationship between social support and heart failure 2) to assess the relationship between self-management behaviors and hospital use for heart failure 3) to measure the extent to which social support mediates the relationship between self-management behavior and hospital use for heart failure. Study participants will be selected using administrative data on hospital discharges from a single large teaching hospital. At study entry, a survey instrument will be administered with validated scales to measure social support and self-management behaviors. In addition, other data on trust in physicians, comorbidities, functional status, medication use and adherence will be collected via the survey. At the end of the 1-year follow-up period, administrative hospital data will be used to measure hospital use for heart failure at the same teaching hospital for all study participants during the previous 12 months. In the data analysis, multivariable modeling will be used to examine the independent relationships of both social support and self- management behaviors with hospital use for heart failure in this diverse cohort. Furthermore, sequential model building will be utilized to determine if social support is a mediator in the relationship between self-management behaviors and hospital use for heart failure. The proposed research will help to elucidate the relationships among these patient factors and hospital use for heart failure. Additionally, the research should inform future work in the design of community-based interventions to augment or optimize social support in efforts to address racial disparities in hospital use for heart failure. PUBLIC HEALTH RELEVANCE: Heart failure affects about 2.6% of adults in the US and is the leading cause of hospitalizations annually among Medicare beneficiaries. Racial disparities in hospital use for heart failure reflect a higher burden of disease among elderly African Americans with heart failure compared to whites. The elucidation of the role of social support as it relates to self-management behaviors and hospital use for heart failure is essential to the creation and implementation of community-based interventions to address these health care disparities.