权益分类	功能权益	普通用户	{{item.name}}会员
{{category.name}}	{{benefitItem.name}}

REDUCTION IN HOSPITALIZATIONS IN LOW-INCOME PATIENTS WITH HEART FAILURE

减少低收入心力衰竭患者的住院率

基本信息

批准号：
7881315
负责人：
LYNDA H POWELL
金额：
$ 67.78万
依托单位：
RUSH UNIVERSITY MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2010
资助国家：
美国
起止时间：
2010-04-01 至 2015-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7881315
关键词：
Activities of Daily Living Acute Adherence Affect Age American Heart Association Behavioral Biological Markers Cardiovascular Diseases Cessation of life Chronic Care Clinical Treatment Communication Community Health Computerized Medical Record Continuing Education Counseling Depressed mood Disadvantaged Education Educational process of instructing Effectiveness of Interventions Electronics Ethnic Origin Event Female Food Frequencies Gender Guidelines Health Personnel Health Status Health education Healthcare Systems Heart failure Hospitalization Hospitals Income Individual Intervention Length of Stay Life Life Style Low income Mental Depression Minority Modeling Outcome Patient Education Patients Persons Pharmaceutical Preparations Pharmacotherapy Population Preventive Primary Health Care Quality of life Questionnaires Randomized Recommendation Recruitment Activity Risk Behaviors Scheme Self Efficacy Self Management Sodium Chloride System Testing Training Work compliance behavior cost design efficacy trial evidence base evidence based guidelines experience follow-up high risk improved pill prevent primary outcome salt intake skills stressor success

项目摘要

Disparities in cardiovascular disease can occur when disadvantaged low-income patients with a serious illness such as heart failure are unable to reap the benefit of life-saving drugs and, as a consequence, experience repeat hospitalizations which are costly in dollars and quality of life. We have observed, in a prior trial, that 53% of low-income patients with heart failure were not receiving evidencebased therapy from their doctors and 37% were not taking at least 80% of the pills they were prescribed. To improve both patient and doctor adherence, and reduce costly repeated hospitalizations, the aim is to conduct a multi-level behavioral randomized efficacy trial that simultaneously intervenes on both doctors and the patients. The primary outcome is all-cause hospitalization days over a 2.5-year follow-up. Using a cluster randomization scheme, the doctors of 320 patients who have income <$30,000 and are hospitalized with acute decompensated heart failure at 3 recruiting hospitals will be randomized to a chronic care treatment or enhanced education control. In the education control, patients will receive standard heart failure education in the form of 12 Tip Sheets from the American Heart Association, and doctors will receive the 2009 ACC/AHA guidelines for the management of heart failure. In the chronic care treatment, both patients and doctors will receive the same information as received in the control. But, in addition, patients will receive training in self-management skills provided by a culturally competent community health worker using an ethnographically-designed heart failure management kit Doctors will receive online and in-person training in the management of patients with heart failure in exchange for continuing education credit. Effectiveness of the intervention will be evaluated not only by the primary endpoint but also by secondary endpoints that include patient adherence to drugs from electronic pill caps, patient adherence to salt restriction from a food frequency questionnaire, doctor adherence to guidelines from electronic medical records, and quality of life. Results will determine whether culturally sensitive approaches to low-income patients and their doctors can reduce hospitalizations over that observed using standard health education and guidelines alone.

心血管疾病的差异可能发生在处于不利地位的低收入患者，严重的疾病，如心脏衰竭，无法获得拯救生命的药物的好处，结果，经历重复住院，这在金钱和生活质量上是昂贵的。我们在之前的一项试验中观察到，53%的低收入心力衰竭患者没有接受医生的循证治疗，37%的患者没有服用至少80%的处方药。为了提高患者和医生的依从性，并减少昂贵的重复住院，目的是进行多层次的行为随机疗效试验，同时干预医生和患者。主要结局是2.5年随访期间的全因住院天数。采用整群随机化方案，将收入<30，000美元且在3家招募医院因急性失代偿性心力衰竭住院的320名患者的医生随机分配至慢性护理治疗或强化教育对照组。在教育对照组中，患者将接受美国心脏协会以12张提示表形式提供的标准心力衰竭教育，医生将接受2009年ACC/AHA心力衰竭管理指南。在慢性病护理治疗中，患者和医生都将收到与对照组相同的信息。但是，除此之外，患者将接受由文化能力强的社区卫生工作者使用人种学设计的心力衰竭管理工具包提供的自我管理技能培训。医生将接受心力衰竭患者管理方面的在线和面对面培训，以换取继续教育学分。干预的有效性不仅将通过主要终点进行评估，还将通过次要终点进行评估，包括患者对电子药丸帽药物的依从性，患者对食物频率问卷中盐限制的依从性，医生对电子病历指南的依从性以及生活质量。研究结果将确定对低收入患者及其医生采取文化敏感的方法是否可以减少仅使用标准健康教育和指导方针所观察到的住院率。