2/2 Video Telehealth Pulmonary Rehabilitation to Reduce Hospital Readmission in Chronic Obstructive Pulmonary Disease (Tele-COPD)

项目摘要/摘要 慢性阻塞性肺疾病(COPD)的急性加重导致显著的发病率和 医疗费用，特别是需要住院的严重恶化。传统的支气管扩张剂和抗哮喘药物 炎症性药物，以及监测和治疗症状的计划，在减少 医院入院。再入院率仍然高得令人无法接受，因此需要采取其他方法。在这 在这方面，肺康复(PR)非常有效，与减少80%的入院有关 费率。成功完成PR还与生活质量、呼吸困难的实质性改善有关，因为 以及运动耐受性。尽管有这些好处，但最近的研究表明，公关的转介率非常低 总体和住院后低至1.9%，而未完成率高达60%。适应能力较差的 社区中的公关是由于可获得性和可获得性方面的障碍以及自然减员造成的。这个 美国的公关中心数量不足，而且这些中心大多分布在城市地区。 此外，多重社会经济和医疗障碍阻碍了获得公共关系的机会，并导致了高辍学率。 需要新的战略来减少COPD患者的再入院，并增加PR的交付到 社区的城市和农村地区都没有得到充分的服务。鉴于现有资源的稀缺性，常规 提供护理的模式正在受到挑战，人们正在努力寻找替代的、具有成本效益的方式 向更多符合条件的患者提供医疗保健。为了克服社会经济和身体上的 PR的障碍，我们假设一种视频远程医疗干预将PR送到患者家中， 无论地理位置如何，都将减少COPD患者的再入院人数，并降低呼吸道发病率。至 为了验证我们的假设，我们提出了一项前瞻性随机对照第三阶段多中心临床试验，比较了 实时视频远程健康公关干预加上护理标准与单独的护理标准相比，具有以下特点 具体目标：(1)确定视频远程健康公关干预是否减少了30天的全原因再入院 COPD急性加重期住院患者，(2)评估视频远程健康公关的效果 干预措施对COPD患者出院后呼吸困难和呼吸生活质量的影响 远程健康干预的成本效益。这项研究目标的实现将带来重大的 COPD再住院率的降低，以及向COPD患者提供PR的方式的范式转变， 特别是那些居住在偏远和农村地区的人，他们获得肺部康复的机会有限。

Project Summary/Abstract Acute exacerbations of chronic obstructive pulmonary disease (COPD) result in significant morbidity and healthcare costs, especially severe exacerbations that require hospitalization. Traditional bronchodilators and anti- inflammatory medications, as well as programs to monitor and treat symptoms, have a modest effect on reducing hospital admissions. Readmission rates remain unacceptably high, so alternative approaches are needed. In this regard, pulmonary rehabilitation (PR) is remarkably effective, and is associated with an 80% reduction in admission rates. Successful completion of PR is also associated with substantial improvements in quality of life, dyspnea, as well as exercise tolerance. Despite these benefits, recent studies have highlighted very poor referral rates for PR overall and as low as 1.9% post-hospitalization, and non-completion rates as high as 60%. The poor adaptation of PR in the community is due to a combination of barriers in availability and accessibility, as well as attrition. The number of PR centers in the United States is inadequate, and these centers are mostly distributed in urban areas. In addition, multiple socioeconomic and medical barriers hinder access to PR, and contribute to high drop-out rates. New strategies are needed to reduce hospital readmission in COPD, and to increase the delivery of PR to underserved urban as well as rural areas in the community. Given the scarcities in existing resources, conventional models of care delivery are being challenged, and attempts are being made to find alternative, cost-effective ways of delivering healthcare to a larger number of eligible patients. To overcome the socioeconomic and physical barriers to PR, we hypothesize that a video telehealth intervention that will deliver PR to the patient's home, regardless of geographic location, will reduce hospital readmissions in COPD, and reduce respiratory morbidity. To test our hypothesis we propose a prospective randomized controlled phase 3 multicenter clinical trial comparing a real-time video telehealth PR intervention plus standard of care versus standard of care alone, with the following Specific Aims: (1) To determine if a video telehealth PR intervention reduces 30-day all-cause readmissions in patients hospitalized for acute exacerbation of COPD, (2) To evaluate the effects of the video telehealth PR intervention on dyspnea and respiratory quality of life in COPD post hospital discharge, and (3) To evaluate the cost-effectiveness of the telehealth intervention. Accomplishment of the aims of this study will result in a significant reduction in COPD readmission rates, and a paradigm shift in the way PR is delivered to patients with COPD, especially those that reside in remote and rural areas with limited access to pulmonary rehabilitation.