Increasing Adherence to Pulmonary Rehabilitation after COPD-related Hospitalizations

项目摘要/摘要 尽管已证实有好处，但接受肺康复(PR)的COPD患者比例为 非常小。目前以中心为基础的公关计划模式无法满足许多患有 慢性阻塞性肺疾病（慢阻肺）。最常见的患者就诊障碍是前往以中心为基础的计划，特别是对于体弱者 需要交通援助的重度COPD患者。以家庭为基础的无人监督的公关 已被提出作为以医院为基础的计划的替代模式，并已被发现是安全和 有效。特别是，住院后PR已被报告为预防 然而，现实情况是，许多时候这不是一种可行的干预措施，因为只有4%的 符合条件的个人可以在入院后坚持公关(出于多种原因)。而慢性阻塞性肺病 每年有近70万人住院治疗，其中许多住院治疗占 COPD每年的直接医疗费用中有很大一部分是潜在的可预防的再入院。 在这个奖项中，我们计划将健康指导添加到公关中，以促进基于我们的 之前的工作(R01 HL09468)，被证明对减少COPD再次住院和 可持续改善生活质量。我们提出了一个简单的远程公关系统，可以填补实践上的空白 基于我们以前的工作(R44 HL114162；Kramer，Pi；Benzo)。将测试一款精致的家居公关 在一项有150名患者参加的强大的第2阶段随机临床试验中，该试验将于R61期和 在R33期间最终敲定。

PROJECT ABSTRACT / SUMMARY Despite proven benefits, the proportion of people with COPD who receive Pulmonary Rehabilitation (PR) is very small. The current model of a center-based PR program fails to address the needs of many patients with COPD. The most common patient barrier to attendance is travel to center-based programs, particularly for frail patients with more severe COPD who need transportation assistance. Home-based, unsupervised PR has been proposed as an alternative model to hospital-based programs and has been found to be safe and effective. In particular PR post-hospitalization has been reported as the most effective intervention to prevent a hosptal readmission; however, the reality is that many times this is not a feasible intervention as only 4% of eligible individuals are able to adhere to PR after a hospital admission (for multiple reasons). While COPD is responsible for nearly 700,000 hospitalizations annually, many of these hospitalizations, which account for a large proportion of the annual direct medical costs of COPD, are potentially preventable readmissions. In this award we plan to add Health Coaching to PR to promote a behavior change based on our previous work (R01 HL09468), that was shown to be highly effective to decrease COPD re-hospitalizations and sustainably improve QOL. We propose a simple system of Remote PR that may fill the practice gap based on our previous work (R44 HL114162; Kramer, PI; Benzo). A refined home-based PR will be tested in a well-powered phase 2 randomized clinical trial of 150 patients that will be started in the R61 period and finalized in the R33 period.