Family members influence quality and delivery of care for heart failure patients

描述（由申请人提供）：项目概述在医疗访问中家属陪伴的存在如何影响护理质量指标方面存在根本差距，例如以患者为中心的沟通（例如，反映尊重患者价值观并将患者的关切和偏好纳入决策的沟通），特别是对于心力衰竭患者-由于其高发病率和死亡率而特别脆弱的人群。该项目的长期目标是改善心力衰竭（HF）患者的护理质量和提供以及随后的健康结果。这里的总体目标，也是我们追求长期目标的下一步，是确定家庭陪伴是否会影响医疗访问中的护理过程，并利用这些信息为干预措施的发展提供信息。拟议研究的基本原理是，一旦我们知道家庭成员如何影响医疗质量和提供，我们就可以履行政策制定者和医疗保健模式的行动呼吁，“与患者及其家属合作，为持续的医疗保健制定一个综合的、连贯的计划”。研究策略是围绕中心假设建立的，即家庭成员参与临床护理将促进患者与提供者的沟通，并可能改善随后的心衰自我管理行为。具体目的是实现我们的总体目标：1)通过以下录音测量来调查家庭伴侣的存在对以患者为中心的沟通的影响：以患者为中心的比率（推进患者议程的沟通与推进提供者议程的沟通的比率），患者激活和参与行为，以及医生促进和患者激活行为；2)评估家庭伴侣的存在对提供者沟通的影响，这些沟通涉及患者对HF自我管理行为（如体重、饮食、症状管理、身体活动和药物依从性）的教育和咨询；3)基于目标1和目标2的定性数据和结果，利用干预映射（IM）设计家庭介入HF干预，并对干预进行预测试。指导的研究、正式教学和计划的演讲/出版物将为临床科学家的独立资助奠定基础。

DESCRIPTION (provided by applicant): PROJECT SUMMARY There is a fundamental gap in how the presence of family companions in medical visits influences indicators of quality of care, such as patient-centered communication (e.g., communication that reflects respect for patients' values and incorporates patient's concerns and preferences into decision-making), specifically for patients with heart failure - a particularly vulnerable population by virtue of its high morbidity and mortality. The long-term goals of this project are to improve the quality and delivery of care and subsequent health outcomes for Heart Failure (HF patients). The overall objective here, which is our next step in pursuit of our long-term goal, is to determine whether family accompaniment influences processes of care within the medical visit and use this information to inform intervention development. The rationale for the proposed research is that once we know how family members influence quality and delivery of care we can fulfill the call to action of policy makers and health care models to "create an integrated, coherent plan for ongoing medical care in partnership with patients and their families." The research strategy is built around the central hypothesis that involvement of family members in clinical care will facilitate patient-provider communication and potentially improve subsequent HF self-management behaviors. The specific aims to achieve our overall objective are: 1) To investigate the impact of family companion's presence on patient centered communication as assessed by the following audio-tape measures: the patient-centeredness ratio (ratio of communication that furthers the patient's agenda to communication that furthers the provider's agenda), patient activation and engagement behaviors, and physician facilitation and patient activation behaviors; 2) To assess the impact of family companion's presence on provider communication related to patient education and counseling about HF self-management behaviors (e.g., weighing, diet, symptom management, physical activity, and medication adherence); and 3) To use intervention mapping (IM) to design a family-involved HF intervention based on qualitative data and results of Aims 1 and 2, and pre-test the intervention. The mentored research, formal didactics, and planned presentations/publications will set the stage for independent funding as a clinician-scientist. PUBLIC HEALTH RELEVANCE: PROJECT NARRATIVE: The proposed research is relevant to public health by seeking to improve the delivery of patient/family centered care for patients with chronic illness by understanding how the patient-physician interaction is influenced by family member accompaniment to medical visits. Thus, the proposed research is relevant to NHLBI's mission to enhance the health of patients living with heart failure so that they can live longer and more fulfilling lives.