Video vs. TTG Respiratory inhaler technique Assessment and InstructioN (V-TRAIN)

描述(由申请人提供)：通过有效使用通过呼吸吸入器提供的治疗，哮喘和慢性阻塞性肺病的恶化住院很可能是可以预防的。有效使用的一个关键限速步骤是正确的吸入器技术。临床指南建议在所有环境中评估和教授吸入器技术。住院患者群体是评估和纠正吸入器技术的一个特别突出的目标，因为住院患者预后不良的风险增加，包括再次住院。医院资源有限，患者保留以医院为基础的教育的能力很可能是不完整的，这将需要出院后教育加强。出于这些原因，开发和测试便携的、有效的以医院为基础的教育策略是必要的。在过去的几年里，我一直在建立一个面对面的“教学目标[TTG]”策略的有效性(几轮评估和演示，直到掌握为止)，指导住院患者正确的吸入器技术。虽然我们发现TTG比简单的口头指令更有效，但它在实施方面存在局限性。首先，它是资源密集型的，其次，它缺乏出院后加固的便携性。因此，在这项提议中，我的目标是研究包括几轮自我评估和基于视频的演示的互动视频模块教育(VME)是否是面对面TTG的一种不逊色的方法。VME直接克服了TTG的局限性，因为它可能资源密集度较低，并且便于退役后增援人员使用。因此，我将开发VME(目标1a)，然后在随机临床试验中测试VME与TTG，按诊断分层，因为哮喘和COPD患者之间存在固有的不同患者和疾病特征(目标1b)。最后，服务不足的患者可能无法在出院后获得VME。因此，我将使用医院医疗数据收集基础设施进行一项观察性研究，以确定能够获得并愿意使用出院后VME的患者比例(目标2)。因此，通过这份K23职业发展奖提案，我将把我的研究经验与我的导师David Meltzer博士、共同导师曾傑瑞Krishnan博士以及一个在阻塞性肺疾病、比较有效性研究以及行为和教育干预领域的专家顾问团队结合在一起，开始填补这些知识和临床实践方面的空白。我将使用这些数据 设计一项R-01可行性和成本效益研究，以确定VME在有足够教育支持的情况下帮助患者从医院过渡到家庭的真实效果，并确定临床结果是否有所改善。这一奖项还将使我能够寻求高级生物统计学方面的额外培训，教育策略开发和评估方面的正式培训，以及复杂行为临床试验的设计和实施方面的培训。这些经验将使我成为开发、评估和实施高质量干预措施的领导者，以改善阻塞性肺疾病患者的自我管理，从而改善临床结果。

DESCRIPTION (provided by applicant): Hospitalizations for exacerbations of asthma and COPD can likely be prevented through effective use of therapies delivered through respiratory inhaler devices. One critical rate-limiting step to effective use is correct inhaler technique. Clinical guidelines recommend assessing and teaching inhaler technique in all settings. The hospitalized patient population is a particularly salient target for evaluating and correcting inhaler technique, as inpatients are at increased risk for poor outcomes, including rehospitalizations. Hospital resources are limited, and patients' ability to retain hospital-based education is likely to be incomplete, which would require post- discharge educational reinforcement. For these reasons, developing and testing portable, effective hospital- based educational strategies are warranted. I have spent the last several years establishing the effectiveness of an in-person "Teach-to-Goal [TTG]" strategy (rounds of assessment and demonstration until mastery is attained) to instruct hospitalized patients on correct inhaler technique. While we have found that TTG is more effective than simple verbal instructions, it has limitations for implementation. First, it is resource intensive and second, it lacks portabilit for post-discharge reinforcement. Therefore, in this proposal I aim to study whether interactive video-module education (VME) that includes rounds of self-assessment and video-based demonstration, is a non-inferior approach to in-person TTG. VME directly counters TTG's limitations as it is likely less resource-intensive and is portable for post-discharge reinforcemen. Therefore I will develop VME (Aim 1a) and then will test VME vs. TTG in a randomized clinical trial, stratified by diagnosis, since there are inherent different patient and disease characteristcs among patients with asthma and COPD (Aim 1b). Finally, underserved patients may not have access to post-discharge VME. I will therefore conduct an observational study using the Hospitalist Medicine Data Collection Infrastructure, to determine the proportion of patients with access to and willingness to use post-discharge VME (Aim 2). Therefore, with this K23 career development award proposal, I will bring my research experience together with my Mentor, Dr. David Meltzer, Co-Mentor, Dr. Jerry Krishnan, and an expert advisory team in the fields of obstructive lung diseases, comparative effectiveness research, and behavioral and educational interventions to begin to fill these gaps in knowledge and clinical practice. I will use these data to design an R-01 feasibility and cost-effectiveness study to determine the real-world effectiveness of VME to help transition patients from hospital to home with sufficient educational support, and to determine if clinical outcomes improve. This award would also allow me to seek additional training in advanced biostatistics, formal training in the development and assessment of educational strategies, and training in the design and implementation of complex behavioral clinical trials. These experiences will position me to become a leader in developing, evaluating and implementing high-quality interventions to improve patient self-management of obstructive lung disease to improve clinical outcomes.