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: 10017297
• 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/10017297
• 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; clinical center; 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.

项目概要 我们的首要目标是增加心肺疾病的入组率、依从性和完成率 社会经济地位较低的多元化人群的康复（CR/PR）；因此我们将采用多管齐下的方式 提高转诊、注册、依从性和完成率的方法。我们的目标是 1) 实施 基于 EHR 的方法增加 CR/PR 转诊，2) 评估选择医院或家庭的效果 康复对入学、依从性和完成情况的影响，以及 3) 评估微推消息对 遵守和完成。该单点试验将在丹佛健康医疗中心进行，该中心是一家大型医疗中心 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程序， Movn，将用于提供家庭康复服务并在患者之间推送信息 随机分配到这些手臂。 在第 1 年（R61 阶段），我们将 1) 实施基于 EHR 的干预措施，2) 进行一系列 N of 1 试验，以 完善推动信息并针对不同受众（包括西班牙语受众）定制干预措施 患者，以及 3) 开发一个单页工具来展示医院和家庭的信息、利弊 为那些随机选择的人进行康复治疗。我们将让患者、提供者和卫生管理者参与进来 提供有关消息和信息表的反馈，并让他们参与日常反馈 在研究期间帮助解决实施的潜在障碍并帮助确保可持续性。在 第一年下半年，我们将开始进行 II 期随机试验。 在第 2-5 年（R33 阶段），在符合 CR 或 PR 条件的患者中，我们将进行患者级别 2x2 随机试验比较：1）基于医院的 CR/PR 和单独使用 Movn； 2) 以医院为基础的 CR/PR 和 Movn 带有轻推消息； 3）选择医院或家庭CR/PR和单独Movn； 4）选择 医院或家庭 CR/PR 和 Movn，带有推送消息。主要成果将是入学、 遵守并完成 CR/PR。该研究还将使用 RE-AIM 框架进行评估。