Peer Support--Congestive Heart Failure Self-Management

同伴支持--充血性心力衰竭的自我管理

• 批准号: 7845812
• 负责人: MARY ELLEN MICHELE HEISLER
• 金额: $ 9.87万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-07-01 至 2010-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7845812
• 关键词: Address; Adherence; Adult; American; Behavior; Behavior Therapy; Behavioral Model; Care given by nurses; Caring; Case Manager; Cessation of life; Chronic; Chronic Disease; Clinic; Communication; Community Healthcare; Congestive Heart Failure; Diabetes Mellitus; Diet; Disease Management; Disease Outcome; Effectiveness; Effectiveness of Interventions; Elements; Ensure; Evaluation; Face; Gender; Goals; Guidelines; Health; Health Services Accessibility; Health Status Indicators; Health system; Healthcare Systems; Heart failure; Home environment; Hospitalization; Indigent; Internet; Intervention; Investments; Knowledge; Lead; Link; Mails; Measures; Mediating; Medical; Metric; Minority; Monitor; Motivation; Multicenter Trials; Nurses; Outcome; Outpatients; Participant; Patient Education; Patient-Focused Outcomes; Patients; Pharmaceutical Preparations; Physiological; Pilot Projects; Process; Quality of life; Randomized; Randomized Controlled Clinical Trials; Randomized Controlled Trials; Recruitment Activity; Relative (related person); Reporting; Research; Research Personnel; Risk; Self Care; Self Efficacy; Self Management; Services; Severity of illness; Social support; Survival Rate; Symptoms; System; Techniques; Technology; Telephone; Time; Training; Treatment Protocols; Treatment outcome; United States; Upper arm; Visit; Visiting Nurse; Voice; Weight; base; chronic pain; cost; cost effectiveness; depression; depressive symptoms; follow-up; health related quality of life; heme oxygenase-1; high risk; hospital readmission; improved; model design; motivational enhancement therapy; multidisciplinary; novel; novel strategies; peer; pressure; programs; response; satisfaction; socioeconomics; therapy development; treatment as usual

DESCRIPTION (provided by applicant): Congestive heart failure (CHF) outcomes depend critically on patients' effective self-management of their condition. Yet, patients with CHF are often frail, indigent, and socially isolated, factors that limit their ability to manage their self-care and access clinic-based services, leading to preventable hospitalizations and poor outcomes. This randomized trial will evaluate a six-month intervention that consists of group visits with CHF nurse managers in conjunction with a low-cost interactive voice response (IVR) telephone exchange system that promotes peer-to-peer communication and facilitates communication with care managers. The intervention is based on research on the positive impact of group visits and peer support on chronic disease outcomes and self-care behaviors, our own studies showing the effectiveness of IVR-based self-management supports, and a successful pilot study. The Specific Aims are:1)To evaluate the effect of group visits + IVR-facilitated peer support on CHF patients' health-related quality of life, survival, and rates of hospital readmission; 2) To assess the impact of the intervention on patients' self-management behaviors, use of guideline-concordant medications, perceived social support, depressive symptoms, and satisfaction with care; 3) To identify the mediating factors influencing the intervention's effectiveness; and 4) To determine the incremental cost-effectiveness of the intervention. 408 moderate to high-risk CHF patients will be recruited in a community health care system serving large numbers of racial minority and socioeconomically vulnerable CHF patients. We will pair eligible patients based on gender and illness severity. Pairs will be randomized to either: 1) usual care; or 2) usual care in conjunction with the intervention. Participants in the intervention arm will receive brief training in Motivational Interviewing-based peer communication techniques and participate in an initial care manager- led interactive group visit. They will then be asked to communicate at least weekly with their partner using the IVR exchange. Pairs will be able to talk by phone but without divulging their home phone number, incurring the cost of long distance calls, or having primary responsibility to ensure that the peer contacts occur regularly. The IVR system also will support "asynchronous" communication between peers using voicemail, as well as between participants and care managers. At months 3 and 6 of the intervention, participants will be invited to participate in group visits encouraging exchange and discussion on CHF self- management. Research staff will monitor the process via the Internet, and outcomes will be measured at six and 12-months. The intervention addresses multiple barriers to effective disease management common among CHF patients. If found effective, this approach could be used to improve health outcomes among patients with other chronic conditions, such as depression, chronic pain, or diabetes.

描述(由申请人提供)：充血性心力衰竭(CHF)的预后关键取决于患者对其病情的有效自我管理。然而，CHF患者往往虚弱、贫穷和社会孤立，这些因素限制了他们管理自我护理和获得基于临床的服务的能力，导致可预防的住院和糟糕的结果。这项随机试验将评估一项为期六个月的干预措施，其中包括与CHF护士经理进行小组访问，以及一个低成本的交互式语音应答(IVR)电话交换系统，该系统促进点对点沟通，并促进与护理经理的沟通。该干预基于团体访问和同伴支持对慢性病结局和自我照顾行为的积极影响的研究，我们自己的研究表明了基于IVR的自我管理支持的有效性，以及一个成功的先导研究。具体目的是：1)评估小组访问+IVR促进的同伴支持对CHF患者健康相关生活质量、生存率和再住院率的影响；2)评估干预对患者自我管理行为、指南一致性药物的使用、感知社会支持、抑郁症状和护理满意度的影响；3)确定影响干预效果的中介因素；4)确定干预的增量成本效益。408名中高危CHF患者将被招募到社区卫生保健系统中，为大量少数民族和社会经济脆弱的CHF患者提供服务。我们将根据性别和疾病严重程度将符合条件的患者配对。PARTS将被随机分为两组：1)常规护理；或2)常规护理配合干预。干预组的参与者将接受基于激励性访谈的同伴交流技术的简短培训，并参加由护理经理领导的最初的互动小组访问。然后，他们将被要求至少每周一次使用IVR交换与他们的伴侣进行交流。Pair将能够通过电话交谈，但不会泄露他们的家庭电话号码，不会招致长途电话的费用，也不会承担确保定期进行同龄人联系的主要责任。IVR系统还将支持使用语音邮件在同行之间以及参与者和护理经理之间进行“异步”通信。在干预的第3个月和第6个月，参与者将被邀请参加小组访问，鼓励就瑞士法郎自我管理进行交流和讨论。研究人员将通过互联网监测这一过程，结果将在6个月和12个月内进行衡量。该干预措施解决了CHF患者中常见的有效疾病管理的多重障碍。如果发现有效，这种方法可以用来改善患有其他慢性疾病的患者的健康结果，如抑郁症、慢性疼痛或糖尿病。

项目成果

Who Signs Up for and Engages in a Peer Support Heart Failure Self-management Intervention.

• DOI: 10.1097/jcn.0000000000000172
• 发表时间: 2015-07
• 期刊: The Journal of cardiovascular nursing
• 作者: Mase R;Halasyamani L;Choi H;Heisler M
• 通讯作者: Heisler M

Randomized controlled effectiveness trial of reciprocal peer support in heart failure.

• DOI: 10.1161/circheartfailure.112.000147
• 发表时间: 2013-03
• 期刊: Circulation. Heart failure
• 作者: Heisler M;Halasyamani L;Cowen ME;Davis MD;Resnicow K;Strawderman RL;Choi H;Mase R;Piette JD
• 通讯作者: Piette JD

Heart failure patients' experiences of a self-management peer support program: a qualitative study.

• DOI: 10.1016/j.hrtlng.2014.04.008
• 发表时间: 2014-07
• 期刊: HEART & LUNG
• 影响因子: 2.8
• 作者: Lockhart, Elizabeth;Foreman, Jane;Mase, Rebecca;Heisler, Michele
• 通讯作者: Heisler, Michele

Barriers and facilitators to learning and performing cardiopulmonary resuscitation in neighborhoods with low bystander cardiopulmonary resuscitation prevalence and high rates of cardiac arrest in Columbus, OH.

• DOI: 10.1161/circoutcomes.111.000097
• 发表时间: 2013-09-01
• 期刊: Circulation. Cardiovascular quality and outcomes
• 作者: Sasson C;Haukoos JS;Bond C;Rabe M;Colbert SH;King R;Sayre M;Heisler M
• 通讯作者: Heisler M