Stepped care versus center-based cardiopulmonary rehabilitation for older frail adults living in rural MA

针对生活在马萨诸塞州农村地区的老年体弱患者的分级护理与中心心肺康复

• 批准号: 10590633
• 负责人: Liana Fraenkel
• 金额: $ 23.3万
• 依托单位: BAYSTATE MEDICAL CENTER, INC.
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-03-15 至 2025-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10590633
• 关键词: Address; Adherence; Cardiac rehabilitation; Cardiopulmonary rehabilitation; Caring; Certification; Community Health Aides; County; Education; Educational Materials; Eligibility Determination; Enrollment; Evaluation; Event; Exercise; Exercise Tolerance; Frail Elderly; Goals; Health; Heart Diseases; Home; Hospitals; Intake; Intervention; Lung diseases; Massachusetts; Measures; Modeling; Outcome; Participant; Patients; Persons; Process; Quality of life; Randomized; Randomized, Controlled Trials; Rehabilitation Centers; Rehabilitation Nursing; Rehabilitation therapy; Research; Resource Allocation; Resource-limited setting; Resources; Rural; Rural Community; Self Management; Single-Blind Study; Site; Specialist; Specific qualifier value; System; Technology; Training; Transportation; Visit; Work; arm; compare effectiveness; cost effectiveness; design; education access; eligible participant; feasibility testing; feasibility trial; functional improvement; improved; individual patient; mobile application; mortality; participant enrollment; patient oriented; programs; pulmonary rehabilitation; readmission rates; remote monitoring; rural area; rural counties; standard of care; telerehabilitation; treatment as usual; trial comparing; uptake; virtual platform

Project Summary Cardiac rehabilitation (CR) decreases mortality and both CR and pulmonary rehabilitation (PR) improve function, quality of life, and decrease readmission rates. Despite their proven efficacy, both programs are grossly underutilized, with fewer than 20% of eligible persons participating. Patients with heart and lung disease living in rural communities have even lower rates of participation. The objective of this proposal is to test the feasibility of performing a full-scale randomized controlled trial (RCT) to compare the effectiveness and value of a stepped care (SC) model versus treatment as usual (TAU) in older frail adults living rural counties. TAU refers to center-based rehabilitation (CBR). The SC model includes initial enrollment into CBR followed by possible step up to three interventions based on prespecified non-response criteria: 1) Transportation-subsidized CBR, 2) Home-based telerehabilitation (TR), and 3) Community health worker-(CHW) supported home-based TR. Unlike traditional SC models, the initial treatment in this model, i.e. CBR, is not the least resource intensive. CBR was chosen as the initial option because it is currently considered the standard of care. We will conduct a parallel, 2-arm, randomized controlled feasibility trial. Eligible participants will be randomized to TAU (CBR) or SC. Because of the urgent need to address underuse of both CR and PR in rural regions, the proposed feasibility trial will enroll patients referred to either CR or PR. Both arms include an in-person intake evaluation conducted by a certified rehabilitation nurse in the rehabilitation center to determine exercise tolerance and design a tailored 8-week rehabilitation program. Patients randomized to TAU participate in two weekly sessions at the center and are encouraged to exercise at home in between sessions. Patients randomized to the SC arm will also be enrolled in the CBR program. Those who meet prespecified non- response criteria will be stepped up to transportation-subsidized CBR. Providing transportation may not be sufficient for frail older adults who are reluctant to leave their homes in the winter, unfamiliar with exercising, or do not want to exercise in a group setting. Thus, non-responders, will be stepped up to home-based TR. Home-based rehabilitation will be supported by Chanl Health, a virtual platform that supports education and self-management, remote monitoring, and coaching by rehabilitation specialists. Non-responders will be stepped up to CHW-supported home-based TR. The CHW will be help participants use the mobile app, access educational materials, clarify educational content, and exercise during biweekly in-person visits. If the feasibility trial is successful, we will proceed to conduct a parallel, 2-arm, single blind, multi-site superiority RCT to compare the effectiveness and value (cost-effectiveness) of SC versus TAU (CBR) in older frail adults living rural counties. Our long-term objective is to provide hospital systems with high quality evidence on how best to optimize uptake of CR and PR for older frail adults living in rural communities.

项目总结