Self-Management Training and Automated Telehealth to Improve SMI Health Outcomes

自我管理培训和自动化远程医疗可改善 SMI 健康成果

• 批准号: 9323574
• 负责人: Stephen J Bartels
• 金额: $ 57.99万
• 依托单位: DARTMOUTH COLLEGE
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-01 至 2019-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9323574
• 关键词: Accident and Emergency department; Action Potentials; Acute; Address; Algorithms; Behavior; Behavioral; Biometry; Blood Pressure; Caring; Chronic; Communities; Comorbidity; Data; Data Collection; Disease Management; Educational process of instructing; Effectiveness; Emergency department visit; General Population; Glucose; Grant; Health; Health behavior; Healthcare; Home Care Services; Home environment; Hospitalization; Individual; Intervention; Knowledge; Lipids; Measures; Mediator of activation protein; Medical; Mental Health; Mental Health Services; Monitor; Monoclonal Antibody R24; Morality; National Institute of Mental Health; Nurses; Outcome; Persons; Pilot Projects; Policies; Premature Mortality; Primary Health Care; Provider; Recovery; Research Infrastructure; Risk; SF-12; Self Management; Self-Administered; Services; Symptoms; Technology; Testing; Tobacco use; Training; base; behavioral health; cardiovascular risk factor; cost; experience; follow-up; healthy lifestyle; high risk; improved; improved outcome; indexing; medication compliance; mortality; prevent; primary outcome; psychiatric symptom; public health relevance; randomized trial; severe mental illness; telehealth

DESCRIPTION (provided by applicant): Efforts to reduce early mortality in persons with serious mental illness (SMI) have largely focused on providing integrated primary care in a "health home". Yet medical care alone accounts for a disproportionately small contribution to reductions in early morality in comparison to improving self-management and health behaviors. Illness self-management training (SMT) in the general population has been shown to improve health outcomes and lower costs associated with chronic health conditions by teaching and coaching individuals on monitoring symptoms, self-administering treatments, and improving health behaviors. More recently, the use of technologies such as Automated Telehealth (AT) has been shown to improve outcomes and potentially prevent expensive emergency room and acute hospitalizations in the general population by daily prompting of self-management and remote monitoring by a nurse who can pre-emptively intervene, guided by disease management algorithms. To our knowledge, neither of these approaches has been empirically evaluated as an integrated component in a behavioral health home for persons with SMI. We propose an RCT of 300 persons with SMI and medical comorbidity to evaluate outcomes for n=100 in a Community Based Health Home alone (CBHH), compared to n=100 also receiving Self-Management Training (CBHH+SMT), and n=100 also receiving Automated Telehealth (CBHH+AT). We will test the following 3 hypotheses: Primary H1: CBHH+SMT and CBHH+AT compared to CBHH alone, will be associated with greater health self-management (measured by the Self Rated Abilities for Health Practices Scale) and (Exploratory E1) greater mental health self-management (measured by the Illness Management and Recovery Scale) at 4, 8, 12, and 24-months. Primary H2: CBHH+SMT and CBHH+AT compared to CBHH alone, will be associated with greater reduction in risk of early mortality (as measured by the Avoidable Mortality Risk Index) and (Exploratory E2) in psychiatric symptoms (BPRS) at 4, 8, 12, and 24 months. Primary H3: CBHH+SMT and CBHH+AT compared to CBHH alone, will be associated with less acute service use (emergency room visits and hospitalizations) and (Exploratory E3) less acute service use costs at 4, 8, 12, and 24-months. In order to differentiate CBHH+SMT and CBHH+AT if both are found to be effective, we will evaluate the persistence of primary outcomes from intervention endpoint (at 12 months) to the final follow-up (at 24 months) and will calculate the additional incremental costs of implementing and providing SMT and AT. We will also explore differences in subjective health (SF-12) and in individual cardiovascular risk factors (e.g., BMI, tobacco use, blood pressure, glucose, lipids), comparing CBHH+SMT, CBHH+AT, and CBHH alone. Finally, we will explore hypothesized mechanisms of action (potential mediators) for the Aim 2 primary outcome of reduced risk of early mortality (i.e., improvement in health self-management) and for the Aim 3 primary outcome of less acute service use (i.e., medication adherence and number of nurse preemptive interventions).

描述（由申请人提供）：降低严重精神疾病（SMI）患者早期死亡率的努力主要集中在“健康之家”中提供综合初级保健。然而，与改善自我管理和健康行为相比，仅医疗保健对早期道德下降的贡献就小得不成比例。事实证明，普通人群的疾病自我管理培训 (SMT) 通过教授和指导个人监测症状、自我管理治疗和改善健康行为，可以改善健康结果并降低与慢性健康状况相关的成本。最近，自动远程医疗 (AT) 等技术的使用已被证明可以改善结果，并有可能避免一般人群昂贵的急诊室和急性住院治疗，方法是每天提示护士进行自我管理和远程监控，护士可以在疾病管理算法的指导下先发制人地进行干预。据我们所知，这两种方法都没有经过实证评估，被认为是 SMI 患者行为健康之家的一个综合组成部分。我们建议对 300 名患有 SMI 和合并症的人进行随机对照试验，以评估仅在社区健康之家 (CBHH) 中的 n=100 人的结果，相比之下，n=100 人同时接受自我管理培训 (CBHH+SMT)，n=100 人也接受自动化远程医疗 (CBHH+AT)。我们将测试以下 3 个假设：主要 H1：与单独 CBHH 相比，CBHH+SMT 和 CBHH+AT 将与 4、8、12 和 24 个月时更好的健康自我管理（通过健康实践自评能力量表衡量）和（探索性 E1）更好的心理健康自我管理（通过疾病管理和康复量表衡量）相关。主要 H2：与单独使用 CBHH 相比，CBHH+SMT 和 CBHH+AT 将与 4、8、12 和 24 个月时早期死亡风险（通过可避免死亡风险指数衡量）和精神症状 (BPRS)（探索性 E2）的更大降低相关。主要 H3：与单独 CBHH 相比，CBHH+SMT 和 CBHH+AT 将与 4、8、12 和 24 个月时较少的急性服务使用（急诊室就诊和住院）和（探索性 E3）较低的急性服务使用成本相关。如果发现 CBHH+SMT 和 CBHH+AT 均有效，为了区分两者，我们将评估从干预终点（12 个月）到最终随访（24 个月）主要结局的持续性，并将计算实施和提供 SMT 和 AT 的额外增量成本。我们还将探讨主观健康 (SF-12) 和个体心血管危险因素的差异 （例如，BMI、吸烟、血压、血糖、血脂），比较 CBHH+SMT、CBHH+AT 和单独的 CBHH。最后，我们将探讨目标 2 主要结局降低早期死亡风险（即改善健康自我管理）和目标 3 主要结局减少急性服务使用（即药物依从性和护士先发性干预的数量）的假设作用机制（潜在中介因素）。