Paramedic Evaluation for Acute COPD Exacerbation: the PEACE Intervention - PROJECT SUMMARY Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of patient morbidity and mortality in the United States, causing 150,000 deaths, 873,000 emergency department visits, and 700,000 hospitalizations annually. COPD exacerbations diminish patient quality of life, widen health disparities, and strain acute care resources. Frequent assessment and early treatment prevent severe COPD exacerbations and emergency services encounters. However, strategies for optimizing timely, effective evaluation and intervention for acute disease symptoms are lacking. Mobile integrated health (MIH) programs, which deploy highly trained paramedics supervised remotely by physicians into the community to care for patients in their homes, may improve COPD care delivery by overcoming barriers to timely evaluation and treatment. There have been no prior investigations of the implementation or effectiveness of MIH initiatives to manage COPD exacerbation. In this proposal, I seek to implement, refine, and evaluate the Paramedic Evaluation for Acute COPD Exacerbation (PEACE) intervention. This program dispatches community paramedics into patients' homes on-demand, in collaboration with ambulatory teams to manage COPD exacerbation proactively. I have evaluated barriers and facilitators to the adoption of MIH to manage COPD exacerbation. I have also demonstrated the feasibility and safety of an MIH program to care for acutely ill, medically complex adults. Using my findings from this preliminary work, I have designed a prototype intervention for managing acute COPD exacerbation. My research plan includes three aims: Aim 1: Test and refine the prototype PEACE intervention to manage COPD exacerbation in community- dwelling adults with moderate to severe COPD. Aim 2: Complete a pilot randomized controlled trial with 50 patients to evaluate the feasibility and preliminary effect of the intervention, and Aim 3: Evaluate implementation, of the PEACE intervention using the PRISM implementation framework. My career goal is to lead hypothesis-driven research that investigates mobile community-based healthcare delivery strategies to improve the lives of patients living with COPD. To help me achieve my aims and career goals, I have developed a training plan that includes: 1) acquiring training and experiential skills in implementation and dissemination methods, 2) obtaining advanced skills in pragmatic clinical trial design and analytic techniques, and 3) enhancing leadership, grantsmanship and writing skills. I will achieve these goals through directed coursework, focused seminars, and practical experience. I am well supported by a highly experienced team of mentors and advisors. At the end of this mentored career development award, I will have an enhanced intervention, robust preliminary data, and a refined research strategy, well-positioning me to perform an R01-funded multi-center trial as an independent investigator.
