The proposed project, """"""""Patient Decision Support and Coaching,"""""""" is a three-year and two month trial of a novel approach to improving the use of secondary prevention following hospitalization for myocardial infarction. The investigators previously developed and pilot tested a program that uses a brief patient decision- support booklet and nurse telephone counseling to """"""""coach"""""""" patients to begin and continue secondary prevention. The intervention, the Heart After-hospital Recovery Planner (HARP), engages the patient, HARP nurse and treating physician(s) in reviewing evidence about medical and behavioral secondary prevention strategies and developing a plan for the patient's recovery. Nurse counselors, based in the hospital, then make follow-up telephone calls at 1, 2, 4 weeks to help solve problems and reinforce decisions made using the HARP booklet. Nurses also """"""""coach"""""""" patients to ask questions at upcoming visits to both primary care and cardiology or cardiac surgeon physicians. The project will serve as a prototype of a combined """"""""decision support and coaching"""""""" intervention. The study is a two-community study, comparing intervention and control communities in Michigan. The study will enroll all English-speaking patients with confirmed myocardial infarction without renal failure who are well enough to be interviewed in-hospital and consent to participate.
The specific aims of the research are to: 1) Determine whether use of HARP leads to improved rates of post-MI physician medication prescribing compared with usual care; 2) Determine whether patients who participate in HARP improve medical and behavioral secondary prevention compared with controls at 3 months and 12 months following hospitalization; 3) Determine whether participation in HARP leads to improved health and well-being, compared with usual care; 4) Determine whether participation in HARP leads to improved perceived heart health competence and participation in decision-making, compared with usual care; 5) Evaluate the cost-utility of HARP compared to usual care. The importance of the HARP intervention lies in its potential to develop decision support and coaching interventions to improve the ability of the health care system to deliver the right care to the right patient, reliably, at the right time. Nationwide, both medical and behavioral secondary prevention is under- utilized. HARP builds on previous research in patient decision- support and telephone counseling to encourage implementation of secondary prevention strategies by patients and physicians. The intervention has been developed in community practice settings to intrude minimally into hospital and office routines. Should HARP prove successful post-MI, it can serve as a prototype delivery vehicle for other evidence-based interventions.

Agency
National Institute of Health (NIH)
Institute
Agency for Healthcare Research and Quality (AHRQ)
Type
Research Project (R01)
Project #
5R01HS010531-03
Application #
6528215
Study Section
Special Emphasis Panel (ZHS1-HSRD-A (04))
Program Officer
Coopey, Margaret
Project Start
2000-09-30
Project End
2003-11-30
Budget Start
2002-09-30
Budget End
2003-09-29
Support Year
3
Fiscal Year
2002
Total Cost
Indirect Cost
Name
Michigan State University
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
193247145
City
East Lansing
State
MI
Country
United States
Zip Code
48824
Olomu, Adesuwa B; Stommel, Manfred; Holmes-Rovner, Margaret M et al. (2014) Is quality improvement sustainable? Findings of the American College of Cardiology's Guidelines Applied in Practice. Int J Qual Health Care 26:215-22
Olomu, Adesuwa B; Corser, William D; Stommel, Manfred et al. (2012) Do self-report and medical record comorbidity data predict longitudinal functional capacity and quality of life health outcomes similarly? BMC Health Serv Res 12:398
Holtrop, Jodi Summers; Stommel, Manfred; Corser, William et al. (2009) Predictors of smoking cessation and relapse after hospitalization for acute coronary syndrome. J Hosp Med 4:E3-9
Dunn, Susan L; Stommel, Manfred; Corser, William D et al. (2009) Hopelessness and its effect on cardiac rehabilitation exercise participation following hospitalization for acute coronary syndrome. J Cardiopulm Rehabil Prev 29:32-9
Corser, William; Sikorskii, Alla; Olomu, Ade et al. (2008) ""Concordance between comorbidity data from patient self-report interviews and medical record documentation"". BMC Health Serv Res 8:85
Holmes-Rovner, Margaret; Stommel, Manfred; Corser, William D et al. (2008) Does outpatient telephone coaching add to hospital quality improvement following hospitalization for acute coronary syndrome? J Gen Intern Med 23:1464-70
Dunn, Susan L; Corser, William; Stommel, Manfred et al. (2006) Hopelessness and depression in the early recovery period after hospitalization for acute coronary syndrome. J Cardiopulm Rehabil 26:152-9