A Mixed Methods Evaluation of Developing COPD Exacerbations in the MARC Cohort

项目总结/摘要 慢性阻塞性肺疾病（COPD）的急性加重增加了发病率， 疾病的死亡率，是其高医疗保健成本的主要驱动因素。急性加重的早期治疗 与全身性皮质类固醇和/或抗生素一起使用已经显示出减轻了它们的许多负面作用。 然而，先前的努力，以检测急性加重早到足以促进门诊管理， 结果喜忧参半。电子监测，远程监测患者的 他们的临床状态，是一种有前途的方法，以检测急性加重之前，提出照顾，促进 早期连接到门诊管理，并防止进展到住院治疗。电子吸入器 监测器可以连接到短效β激动剂（SABA）吸入器以记录每次致动并传输 这些数据给医疗团队。因为患者被告知要对恶化的症状做出反应， 越来越多地使用他们的SABA吸入器，检测这种使用增加的电子吸入器监测器可能是 识别临床恶化的潜在工具。然而，很少有研究探讨使用 在COPD急性加重的早期阶段使用电子吸入器监测器。 为了解决这一知识差距，我们将对现有的队列进行二次数据分析。 >250名COPD患者入组COPD患者药物依从性研究（MARC R 01 HL 128620：PI Eakin）研究。作为MARC研究的一部分，参与者每周接受电子监控， 症状日志，电子吸入器监测器，每月电话收集最近 在12个月的监测期内，在具体目标1中，我们将利用这些数据来证明 随着呼吸道症状的恶化，SABA的使用量增加，然后检查这些SABA的增加是否 使用与中度或重度加重的几率增加相关。因为之前的研究 表明，并非所有症状恶化的患者都按照《特定目标》中的指示增加SABA的使用， 我们将评估患者水平的风险因素，如认知功能低下，是否与此相关。 自我管理能力差。在具体目标3中，我们将使用半结构化 以自我调节理论为框架的访谈，探讨参与者的思维过程 在症状恶化期间的自我管理。因此，这项研究不仅 评估呼吸道症状、SABA使用和急性加重之间的关联，但也寻求摆脱 轻患者亚组的斗争，以有效地自我管理其恶化的症状。 本建议书将为申请人提供必要的培训， 追求作为COPD健康服务研究人员的独立职业所需的定性技能。

Project Summary/Abstract Acute exacerbations of chronic obstructive pulmonary disease (COPD) increase the morbidity and mortality of the disease and are the major drivers of its high healthcare costs. Early treatment of exacerbations with systemic corticosteroids and/or antibiotics has been shown to mitigate many of their negative effects. However, prior efforts to detect exacerbations early enough to facilitate outpatient management have demonstrated mixed results. Electronic monitoring, in which patients are remotely monitored for changes in their clinical status, is a promising approach to detect exacerbations prior to presentation to care, facilitate earlier connection to outpatient management, and prevent progression to hospitalization. Electronic inhaler monitors can be attached to short-acting beta agonist (SABA) inhalers to record each actuation and transmit that data to the healthcare team. Because patients are instructed to respond to worsening symptoms by increasing use of their SABA inhalers, electronic inhaler monitors which detect this increase in use may be a potential tool to identify clinical worsening. However, there has been little research examining the use of electronic inhaler monitors in the early stages of a COPD exacerbation. To address this knowledge gap, we will conduct a secondary data analysis of an existing cohort of >250 patients with COPD enrolled into the Medication Adherence Research in COPD Patients (MARC R01 HL 128620: PI Eakin) study. As part of the MARC study, participants are monitored with weekly electronic symptom logs, electronic inhaler monitors, and monthly phone calls collecting information on recent exacerbations for a 12-month monitoring period. In Specific Aim 1, we will leverage this data to demonstrate that SABA use increases as respiratory symptoms worsen and then examine whether these increases in SABA use are associated with increased odds of a moderate or severe exacerbation. Because prior research suggests that not all patients with worsening symptoms increase their SABA use as instructed, in Specific Aim 2 we will evaluate whether patient-level risk factors, such as low cognitive functioning, are associated with this type of poor self-management. In Specific Aim 3, we will conduct a qualitative study using semi-structured interviews guided by the framework of Self-Regulation Theory to explore participants’ thought processes around their self-management during periods of worsening symptoms. This research will therefore not only evaluate the associations among respiratory symptoms, SABA use, and exacerbations but also seeks to shed light on patient subgroups that struggle to effectively self-manage their worsening symptoms. This proposal will provide the applicant with the necessary training to develop the quantitative and qualitative skills needed to pursue an independent career as a health services researcher in COPD.