Improving Participation in Cardiac Rehabilitation among Lower-Socioeconomic Status Patients: Efficacy of Early Case Management and Financial Incentives

项目总结 参与门诊心脏康复治疗可降低住院患者的发病率和死亡率 心肌梗死、冠状动脉搭桥术或经皮血管重建术。不幸的是，只有10- 有CR指征的患者中有35%选择参与。较低的社会经济地位(SES)是一种强势 CR不参与的预测因子。越来越多的人认识到有必要在经济上 对处境不利的患者进行干预，但几乎没有基于证据的干预措施可用来这样做。在 目前，我们正在研究使用早期病例管理和财政激励措施的有效性 增加低SES患者的CR参与率。案例管理有效地促进了 参加各种与健康有关的方案(例如糖尿病、艾滋病毒、哮喘、可卡因的治疗 依赖)以及减少住院治疗。财政激励在改变环境方面也非常有效。 弱势人群的健康行为(例如，怀孕期间吸烟、减肥)包括 CR参与我们之前的试验。在这项研究中，我们将200名符合CR标准的低SES患者随机分为：A 在住院期间有一名病例经理负责协助CR的治疗条件 参加并协调心脏护理，这是一种治疗条件，在这种情况下，他们可以获得经济奖励 视是否开始和继续出席协调委员会会议而定，这两种干预措施相结合， 或者“照常照顾”的状态。所有条件下的参与者都将完成治疗前和治疗后的评估。 治疗条件将根据CR的出勤率和干预结束后的体能改善情况进行比较， 执行功能，以及与健康相关的生活质量。治疗条件的成本效益也将 通过比较提供干预措施的成本和通常的护理条件进行检查 CR参与率的帐户增加。此外，我们将根据以下内容对干预措施的价值进行建模 一年后参与率、干预成本、长期医疗成本和健康结果的增加 冠脉事件。这种对有希望的干预措施的系统检查将使我们能够测试有效性和 有可能大幅增加CR参与率的方法的成本效益 显著改善SES较低的心脏病患者的健康状况。

PROJECT SUMMARY Participation in outpatient cardiac rehabilitation (CR) decreases morbidity and mortality for patients hospitalized with myocardial infarction, coronary bypass surgery or percutaneous revascularization. Unfortunately, only 10- 35% of patients for whom CR is indicated choose to participate. Lower socioeconomic status (SES) is a robust predictor of CR non-participation. There is growing recognition of the need to increase CR among economically disadvantaged patients, but there are almost no evidence-based interventions available for doing so. In the present study we are examining the efficacy of using early case management and financial incentives for increasing CR participation among lower-SES patients. Case management has been effective at promoting attendance at a variety of health-related programs (e.g. treatment for diabetes, HIV, asthma, cocaine dependence) as well as reducing hospitalizations. Financial incentives are also highly effective in altering health behaviors among disadvantaged populations (e.g., smoking during pregnancy, weight loss) including CR participation in our prior trial. For this study we will randomized 200 CR-eligible lower-SES patients to: a treatment condition where there are assigned a case manager while in hospital who will facilitate CR attendance and coordinate cardiac care, a treatment condition where they receive financial incentives contingent on initiation of and continued attendance at CR sessions, a combination of these two interventions, or to a “usual-care” condition. Participants in all conditions will complete pre- and post-treatment assessments. Treatment conditions will be compared on attendance at CR and end-of-intervention improvements in fitness, executive function, and health-related quality of life. Cost effectiveness of the treatment conditions will also be examined by comparing the costs of delivering the interventions and the usual care condition taking into account increases in CR participation. Furthermore, we will model the value of the interventions based on increases in participation rates, intervention costs, long-term medical costs, and health outcomes after a coronary event. This systematic examination of promising interventions will allow us to test the efficacy and cost-effectiveness of approaches that have the potential to substantially increase CR participation and significantly improve health outcomes among lower-SES cardiac patients.