A mixed methods study to identify and refine implementation strategies to increase use of cardiac rehabilitation for patients with heart failure

项目总结 超过650万美国成年人患有心力衰竭，导致大约100万人入院 每年在65岁及以上的患者中。心脏康复(CR)，一个多学科结构的次要学科 应用有效的生活方式疗法以降低继发性心脏事件风险的预防计划 改善功能状态，已证明心力衰竭患者的预后改善，射血减少 分数(HFrEF)。美国心脏协会和美国心脏病学会建议 为心力衰竭患者提供运动培训，2014年，医疗保险和医疗补助服务中心开始 为HFrEF患者报销CR。然而，国家数据显示，只有2%的心力衰竭患者参加 我们的初步数据表明，自2014年以来几乎没有改善。 我们的长期目标是改善心力衰竭患者的健康和预后。父母的目标 建议确定实施策略，增加心力衰竭患者的CR参与率。我们 正在努力完成家长提案目标1(分析最近住院的医疗保险索赔 心衰患者)和AIM 2(进行定性访谈以确定CR的促进者和障碍 参与和实施战略)。然后，在目标3中，我们将把我们的发现提交给 将确定战略优先顺序的利益相关者。目标4是CR实践子集中选定策略的试点， 然后制定建议，增加心衰患者CR的实施。当我们开始 准备Delphi小组，该小组将确定战略的优先顺序，我们意识到HF和战略的CR障碍 解决这些障碍是紧密相连的。这对AIM 4有影响：试点地点将难以选择 如果他们不找出他们计划中CR的当地障碍，他们就不会采取可能的策略。因此，我们 提出四个补充目标以确保目标4的成功。这些目标将由一位杰出的 毕业后的研究员(亚历克西斯·斯图尔特饰)，他也是一个代表性不足的少数群体的成员。 在她的导师和整个研究团队的支持下，她将：1)确定试点特定的障碍 心衰患者的转诊、登记和参与；2)协助试点站点配对已确定的 针对特定地点障碍的实施战略；3)促进创建学习社区，使其能够 试点站点在将实施战略付诸实施时相互支持；4)收集质量 关于目标4中试行的战略的可接受性和适当性的反馈。 斯图尔特将成为一名有竞争力的博士申请者，并最终成为一名独立研究员。他们也是 与国家心肺血液研究所的战略目标和目标保持一致，具体地说 目标6，旨在“优化翻译、临床和实施研究，以改善健康和 减少疾病。“

PROJECT SUMMARY More than 6.5 million American adults have HF, which results in approximately 1 million hospital admissions per year in patients 65 year and older. Cardiac rehabilitation (CR), a multidisciplinary structured secondary prevention program that applies effective lifestyle therapies to reduce the risk of secondary cardiac events and improve functional status, has demonstrated improved outcomes in patients with HF and reduced ejection fraction (HFrEF). The American Heart Association and the American College of Cardiology recommend exercise training for patients with HF, and, in 2014, the Centers for Medicare and Medicaid Services began to reimburse CR for patients with HFrEF. However, national data suggest that only 2% of patients with HF attend CR after a hospitalization, and our preliminary data suggest that little improvement has occurred since 2014. Our long-term goal is to improve the health and outcomes of patients with HF. The objective of the parent proposal is to identify implementation strategies that increase participation in CR among patients with HF. We are working to complete parent proposal Aim 1 (analysis of Medicare claims among recently hospitalized patients with HF) and Aim 2 (to conduct qualitative interviews to identify facilitators and barriers to CR participation and implementation strategies). We will then, in Aim 3, present our findings to a panel of stakeholders who will prioritize strategies. Aim 4 is a pilot of selected strategies in a subset of CR practices and then development of recommendations to increase implementation of CR in patients with HF. As we began to prepare for the Delphi panel that will prioritize strategies, we realized that barriers to CR for HF and strategies to address those barriers are tightly linked. This has implications for Aim 4: pilot sites will struggle to choose from possible strategies if they do not identify the local barriers to CR within their program. Therefore, we propose four supplemental aims to ensure the success of Aim 4. These aims will be led by an outstanding post-baccalaureate researcher (Alexis Stewart) who is also a member of an under-represented minority group. With support from her mentors and the entire study team, she will: 1) Identify pilot site-specific barriers to referral, enrollment, and participation among patients with HF; 2) Assist pilot sites in pairing the list of identified implementation strategies to site-specific barriers; 3) Facilitate creation of a learning community that allows pilot sites to support each other as they put implementation strategies into practice; 4) Collect qualitative feedback on the acceptability and appropriateness of strategies piloted in Aim 4. These aims will help Ms. Stewart to become a competitive PhD applicant and, eventually, independent researcher. They are also consistent with National Heart, Lung, and Blood Institute’s Strategic Goals and Objectives, specifically objective 6, which aims to “optimize translational, clinical, and implementation research to improve health and reduce disease.”