The nominee for this VA Career Development Award is Alexis Beatty, MD MAS, a Staff Cardiologist at the VA Puget Sound Health Care System and Assistant Professor at the University of Washington. The primary goal of this award is to facilitate the development of the nominee into an independent health services investigator with the training and experience necessary to conduct research on innovative patient-centered interventions to improve cardiovascular health. This research will develop and test a multi-component intervention for home cardiac rehabilitation that uses mobile technology. Cardiac rehabilitation is a program of exercise training, risk factor modification, and psychosocial counseling that reduces mortality and hospitalizations and improves health status in patients with heart disease. However, only 19% of eligible Medicare patients and 8% of eligible Veterans receive this guideline-recommended treatment. Most cardiac rehabilitation programs require patients to travel to a facility for rehabilitation sessions three times per week for twelve weeks, which represents a significant barrier for many patients. Home cardiac rehabilitation is an acceptable alternative to facility-based cardiac rehabilitation, but has other challenges related to patient and provider communication. Mobile technology can provide access to health interventions, motivate patients to engage in healthy behaviors, and facilitate patient-provider communication. The nominee partnered with the VA Office of Connected Care to develop a patient mobile application for cardiac rehabilitation and corresponding provider mobile application for viewing patient- generated data. However, little is known about whether using mobile technology for home cardiac rehabilitation will improve outcomes or how to integrate the use of mobile technology into the health care system.
The specific aims of this research are: (1) Identify barriers and facilitators to use of a mobile application for cardiac rehabilitation among Veterans. Veterans enrolled in home cardiac rehabilitation will use the mobile application at home for 1 month, complete questionnaires, and participate in interviews about their experience. (2) Determine provider-level adaptations for the intervention. Providers and key stakeholders will participate in interviews about integrating the use of mobile technology into clinical care and develop strategies for integrating mobile technology into workflow. (3) Pilot test a home cardiac rehabilitation intervention that uses mobile technology. Veterans enrolled in home cardiac rehabilitation will be randomized to receive home cardiac rehabilitation either with or without an intervention that is facilitated by mobile technology. The primary goal will be to determine the feasibility of enrolling Veterans in a study of the intervention. The secondary goal will be to determine whether the intervention leads to greater participation in cardiac rehabilitation. In addition to the experience that Dr. Beatty will gain in conducting this research, she will receive structured training in patient-centered interventions, implementation science, and health informatics. Dr. Beatty will conduct her research and training under the mentorship of a team of experts in health services research: Mary Whooley, MD (patient-centered interventions, home cardiac rehabilitation), John Fortney, PhD (implementation science, virtual care interventions), and Michael Ho, MD, PhD (cardiovascular patient-centered interventions, implementation science). The research and training activities of this award will prepare the nominee to conduct a multi-site hybrid implementation-effectiveness trial of the effect of the intervention on cardiac rehabilitation participation, physical activity, exercise capacity, health status, and cardiovascular events in patients with heart disease who are eligible for cardiac rehabilitation. Ultimately, this award will help the nominee develop into an independent health services investigator studying innovative patient-centered interventions to improve cardiovascular health.
Cardiac rehabilitation improves health and quality of life in patients with heart disease. However, only 8% of Veterans who are eligible for cardiac rehabilitation actually attend. A major challenge is that our current system of cardiac rehabilitation requires most patients to travel to a cardiac rehabilitation facility three times per week for twelve weeks, which is difficult for many people. This research will develop and test a home cardiac rehabilitation program that uses mobile technology to make it easier for Veterans to participate in cardiac rehabilitation at home. The program will be designed with input from Veterans and health care providers so that it responds to Veterans? needs and is able to be included within the existing system of providing health care. A home cardiac rehabilitation program that uses mobile technology has the potential to increase the number of Veterans who are able to participate in cardiac rehabilitation and improve health and quality of life in Veterans with heart disease.