Leveraging Home Health Aides to Improve Outcomes in Heart Failure

项目总结/摘要 心力衰竭（HF）影响美国600万人，每年花费超过300亿美元，导致100万人死亡。 每年住院。25%的Medicare受益人在30天内重新入院， HF，但以前的干预措施，以减少再入院有好坏参半的结果。一种尚未开发的潜在资源 这种干预措施可能是聘请家庭健康助理（HHA）; HF住院后，25%的患者 在HHA的支持下出院回家。与医生或访问护士不同，HHA与患者在一起， 几乎每天一次，有时一天24小时。然而，候选人之前的工作表明， 没有接受HF的专门教育，对HF患者缺乏信心。事实上，HHA承认 当他们不确定该怎么做时，或者如果他们无法联系到他们的机构护士， 建议.虽然有些急诊室就诊在临床上可能是合适的，但许多急诊室就诊是可以避免的。 本提案的目的是设计和测试一种新的干预措施， 为他们提供一个基于平板电脑的消息传递工具，将他们与他们的主管护士联系起来。整体 一个假设是，受过教育和整合的HHA可以改善HF的结局。在现有基础上 基于社区的合作，该项目将与1199 SEIU家庭护理行业进行 教育基金（一个培训来自纽约55家有执照的家庭护理机构的75 000名HHA的组织， 纽约）和访问护士服务的纽约（最大的非营利性许可家庭护理机构在美国）。 该项目将包括一项HHA调查，以衡量HF培训差距和偏好的普遍性， 干预措施（目标1）;一个参与者参与的过程，以设计一个基于教育和通信的 干预（目标2）;和一个试点随机对照试验，以测试的可行性和可接受性， 这是一项新的干预措施（目标3），为未来的R 01奠定基础，该R 01将在更大范围内测试其有效性。 这个职业发展奖的候选人，玛德琳斯特林，医学博士，公共卫生硕士，MS，是一个普通内科医生， 临床医学、流行病学和卫生服务研究方面的专业知识。这个奖项将使她获得 在现实世界中开发和开展临床试验的技能，旨在改善医疗保健 HF患者的分娩和结局。斯特林博士将由两名NHBLI资助的临床医生指导- 研究者Monika Safford，MD（主要导师;现实世界临床试验专家）和丽莎克恩，MD，公共卫生硕士 （共同导师;旨在改善门诊护理的干预措施评估专家）。其他顾问， HF、家庭护理、技术和实施科学方面的专业知识也将指导她。 导师制，正式的课程，以及拟议的体验式学习将使斯特林博士成为一名 独立研究者，同时推进HF患者的家庭护理和医疗保健提供领域。

Project Summary/Abstract Heart failure (HF) affects 6 million people in the US, costs over $30 billion per year, and results in 1 million hospitalizations per year. Readmission within 30 days occurs in 25% of Medicare beneficiaries admitted for HF, but previous interventions to reduce readmissions have had mixed results. An untapped potential resource for such interventions may be to engage home health aides (HHAs); after a HF hospitalization, 25% of patients are discharged home with support from HHAs. Unlike physicians or visiting nurses, HHAs are with patients on a near-daily basis, sometimes up to 24 hours per day. However, the candidate’s prior work suggests that HHAs do not receive HF-specific education and lack confidence caring for HF patients. Indeed, HHAs acknowledge that they often call 911 when they are unsure of what to do, or if they cannot reach their agency nurse for advice. While some emergency department visits may be clinically appropriate, many may be avoidable. The objective of this proposal is to design and test a novel intervention that will educate HHAs about HF and provide them with a tablet-based messaging tool that connects them with their supervising nurses. The overall hypothesis is that educated and integrated HHAs can improve outcomes in HF. Building on established community-based collaborations, the project will be conducted with the 1199SEIU-Home Care Industry Education Fund (an organization that trains 75,000 HHAs from 55 licensed home care agencies in New York, NY) and the Visiting Nurse Service of New York (the largest non-profit licensed home care agency in the U.S.). The project will include a survey of HHAs to measure the prevalence of HF training gaps and preferences for an intervention (Aim 1); a stakeholder-engaged process to design an educational and communication-based intervention (Aim 2); and a pilot randomized controlled trial to test the feasibility and acceptability of the intervention (Aim 3), laying the groundwork for a future R01 which will test its effectiveness on a larger scale. The candidate for this career development award, Madeline Sterling, MD, MPH, MS, is a general internist with expertise in clinical medicine, epidemiology, and health services research. This award will enable her to gain skills in the development and conduct of clinical trials in real-world settings designed to improve healthcare delivery and outcomes for HF patients. Dr. Sterling will be mentored by two NHBLI-funded clinician- investigators, Monika Safford, MD (primary mentor; expert in real-world clinical trials) and Lisa Kern, MD, MPH (co-mentor; expert in the evaluation of interventions designed to improve ambulatory care). Other advisors with expertise in HF, home care, technology, and implementation science will also guide her. The combination of mentorship, formal coursework, and the proposed experiential learning will position Dr. Sterling to become an independent investigator while advancing the field of home care and healthcare delivery for HF patients.