Enhancing cardiac and pulmonary rehabilitation adherence through home-based rehabilitation and behavioral nudges: ERA Nudge

通过家庭康复和行为助推提高心肺康复的依从性：ERA Nudge

• 批准号: 9791472
• 负责人: PAMELA N PETERSON
• 金额: $ 72.12万
• 依托单位: DENVER HEALTH AND HOSPITAL AUTHORITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-15 至 2023-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9791472
• 关键词: Activities of Daily Living; Address; Adherence; Administrator; Adoption; Behavior; Behavioral; Behavioral Sciences; Car Phone; Cardiac rehabilitation; Cellular Phone; Clinical; Cognitive Science; Educational Background; Effectiveness; Enrollment; Ensure; Failure; Feedback; Goals; Health; Health Personnel; Health behavior; Health system; Home environment; Hospitalization; Hospitals; Intervention; Libraries; Location; Maintenance; Medical center; Methods; Minority; Motivation; Outpatients; Patient Outcomes Assessments; Patient-Focused Outcomes; Patients; Phase; Population; Population Heterogeneity; Program Accessibility; Provider; Quality of life; Randomized; Recommendation; Rehabilitation therapy; Screening procedure; Series; Site; Study Subject; System; Techniques; Technology; Testing; Transportation; Veterans; Vulnerable Populations; Woman; Work; arm; base; behavioral economics; compliance behavior; design; disadvantaged population; disparity reduction; ethnic diversity; exercise capacity; flexibility; health care service utilization; improved; low socioeconomic status; mHealth; patient engagement; patient population; primary outcome; programs; pulmonary rehabilitation; randomized trial; safety net; secondary outcome; theories; tool; treatment arm; trial comparing; uptake

PROJECT SUMMARY Our overarching goal is to increase enrollment, adherence and completion of cardiac and pulmonary rehabilitation (CR/PR) in a diverse population of low socioeconomic status; thus we will use a multi-pronged approach to increase referral, enrollment, adherence and completion. Our objectives are to 1) implement an EHR-based approach to increase referral to CR/PR, 2) evaluate the effect of choice of hospital or home-based rehabilitation on enrollment, adherence and completion and 3) evaluate the effect of nudge messaging on adherence and completion. This single site trial will be performed at Denver Health Medical Center, a large urban integrated safety net health system. We will provide all patients with the cellphone-based application, Movn, which will be used to deliver home-based rehabilitation and nudge messaging among patients randomized to those arms. In year 1 (R61 phase), we will 1) implement EHR-based interventions, 2) conduct a series of N of 1 trials to refine the nudge messages and tailor the interventions for diverse audiences, including Spanish-speaking patients, and 3) develop a one-page tool to present information, pros and cons of hospital and home-based rehabilitation for those randomized to choice. We will engage patients, providers, and health administrators to provide feedback on the messages and the information sheet, as well as engaging them in routine feedback during the study to help address potential barriers to implementation and help ensure sustainability. In the latter half of year 1, we will begin enrollment in the Phase II randomized trial. In years 2-5 (R33 phase), among patients eligible for CR or PR, we will conduct a patient level 2x2 randomized trial comparing: 1) hospital-based CR/PR and Movn alone; 2) hospital-based CR/PR and Movn with nudge messaging; 3) choice of hospital or home-based CR/PR and Movn alone; and 4) choice of hospital or home-based CR/PR and Movn with nudge messaging. The primary outcomes will be enrollment, adherence and completion of CR/PR. The study will also be evaluated using the RE-AIM framework.

项目摘要 我们的总体目标是增加心脏和肺的入学，遵守和完成 康复（CR/PR）的社会经济地位低不同；因此，我们将使用多管齐下的 增加推荐，入学，依从性和完成的方法。我们的目标是1）实施 基于EHR增加转介到CR/PR的方法，2）评估医院或家庭选择的效果 恢复入学，依从性和完成以及3）评估微调消息对 依从性和完成。这项单场试验将在丹佛健康医疗中心进行，这是一个大型的 城市综合安全网卫生系统。我们将为所有患者提供基于手机的应用， Movn，该Movn将用于在患者中提供基于家庭的康复和微调消息传递 随机分配给那些武器。 在第1年（R61阶段），我们将1）实施基于EHR的干预措施，2）进行1个试验中的一系列n 完善轻推信息，并为不同的受众量身定制干预措施，包括说西班牙语 患者，以及3）开发一页工具，以提供医院和家庭的信息，利弊 那些随机选择的人的康复。我们将使患者，提供者和卫生管理员与 提供有关消息和信息表的反馈，并让他们参与常规反馈 在研究期间，以帮助解决实施潜在的障碍并帮助确保可持续性。在 下半年，我们将开始参加II期随机试验。 在2 - 5年（R33期）中，在有资格获得CR或PR的患者中，我们将进行患者2x2级 比较随机试验：1）基于医院的CR/PR和MOVN单独进行； 2）基于医院的CR/PR和MOVN 通过微调消息传递； 3）单独选择医院或家庭的CR/PR和MOVN； 4）选择 医院或家庭的CR/PR，并带有微调消息传递。主要结果将是注册， CR/PR的依从性和完成。该研究还将使用RE-AIM框架进行评估。