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CORPS Program (Caregivers Optimizing Readiness through Prevention Strategies) (2007)

The leadership at Walter Reed Army Medical Center (WRAMC) has recognized a high degree of stress among nurses caring for the steady stream of ill and wounded Soldiers returning from Afghanistan and Iraq.  The high level of stress affects individual medical readiness, job satisfaction, and cardiovascular (CV) health, as well as nurse retention.  Consequently, the Deputy Commander of Nursing requested the development of a stress reduction program for her personnel.  Broader discussions with senior Army leaders have brought to light the need for similar stress reduction and CV wellness among executive leaders of the US Army Staff.  These needs and requests for interventions dovetailed well with the goals of the Integrative Cardiac Health Project (ICHP) at WRAMC.  ICHP is a congressionally funded CV disease prevention program directed by COL Marina Vernalis MC (Ret) and comprised of a cardiologist, sleep specialist, psychologist, nurse practitioner, nutritionist, exercise physiologist, and stress management instructor.  ICHP successfully reduces CV risk through stress reduction, dietary change, exercise, and sleep improvement.

ICHP has received Congressional funding to implement and study a CV risk and stress reduction program applicable to nurses, allied health care providers, and executive level leaders.  This program for improving corporate wellness is intended to supplement the activities of best medical practices currently available as the standard of care in the Army Medical Department.  The newly funded initiative is called the CORPS Program (Caregivers Optimizing Readiness through Prevention Strategies).  The mandate for ICHP's CORPS allows program implementation in a phased manner at a number of different sites, includes systematic evaluation of new biometric assessment tools, and incorporates the use of an electronic personalized health record (ePHR).  The clinical CORPS program will be complimented by an investigational CORPS research protocol.

The prospective CORPS research protocol will consist of two phases:

Phase 1

Study volunteers will be randomized to a 12-week lifestyle change program or to a waiting list control group who may subsequently choose to enter the intervention arm.  At intake, all subjects will complete a comprehensive health risk assessment which includes conventional and emerging risk profiles for the development of CV disease.  The CV risk assessments will utilize the Framingham criteria augmented by other new risk factors incorporated in a novel ICHP CV Risk Score.  Also included in the comprehensive risk assessments are anthropometric data, laboratory data, medical and Family history, and carotid intima-medial thickness (CIMT) measurement by ultrasound.  Other assessment tools at study intake will evaluate lifestyle behaviors that are known to affect CV health.  Discovery of unhealthy behaviors will afford opportunities to attempt lifestyle changes that may lead to CV risk reduction and improved quality of life.  These lifestyle behavior assessments will utilize validated questionnaires that measure stress levels (including compassion fatigue and burnout), evaluate sleep quantity and quality, assess dietary habits, and quantify exercise and activity levels.  Results from all of these assessments will be reviewed by an expert panel and individual risk scores and personalized recommendations for lifestyle changes will be summarized in a contextualized report for the patient participant and for the patient's primary care provider.

The central role of inflammation in the initiation and progression of CV disease is now generally accepted.  However, the pathogenic role of various inflammatory stimuli in CV disease remains less clear.  To investigate the role of commonly experienced inflammatory stimuli, we intend to query participants on their allergies and immune reactions to aeroallergens, medications, immunizations, and asthma, while we link with and query the e-immune database on immunizations received in the course of participants' military service.  We anticipate that studying the interplay between CV disease risk and immune responses will demonstrate useful correlations.

Biometric assessment tools will also be used to collect objective data during the baseline measurement phase.  Participants and control subjects will wear a noninvasive biometric monitor (armband or vest sensewear) for the 12-week intervention period to gather information such as body temperature, ambient temperature of the environment, galvanic skin response, motion, and respirations.  This biological information will be processed using validated artificial intelligence algorithms to provide accurate estimates of energy expenditure, exercise activities, non-exercise activity levels, stress levels, and sleep health.

Upon completion of the baseline assessments, participants will enter the 12-week program of intervention.  Waiting list control subjects will not receive the program of intervention but will be afforded usual care for the 12-week period.  After12 weeks, a reassessment of CV risk factors and lifestyle habits will be performed.  Comparison between participant and control groups will be made to quantify reduction in CV risk and adherence to healthy lifestyle recommendations in the domains of diet, exercise, stress management and sleep health.  At the end of 12 weeks, waiting list control subjects will be eligible to enter the intervention arm of the study if they choose.

The 12-week CORPS intervention will begin with a 3-hour Jumpstart Heart Smart Workshop comprised of interactive education, an “eating right” demonstration, fitting of and education on the biometric sensewear device, a participatory stress reduction session, and delivery of personalized health reports and recommendations for healthy lifestyle choices.  Subsequently, participants will engage in 11 two-hour on-site group sessions consisting of an hour of exercise, combined with an hour of “Healthy Talk” or participatory stress reduction.  Biometric data from the non-invasive monitoring devices will be down-loaded at each weekly session to generate feedback reports and to identify participants in need of additional support.  At the end of the 12-week CORPS intervention, patients will enter Phase 2 of the prospective CORPS research protocol.

Phase 2

Graduates of the 12-week CORPS intervention are eligible to participate in Phase 2.  Volunteers will be randomized to an arm of usual care (control group) or to an arm of more intensive follow up with resources to include an empowering, enhanced, electronic personal health record (e3PHR), health coaches and decision support tools.  In Phase 2, both control and intervention groups will receive an electronic personal health record (ePHR) armed with email notifications constituting a preventive health care calendar.  However, the intensive follow up group will have additional features in the ePHR, hence an e3PHR, with an active learning network, contact with health coaches, decision support tools and a dashboard like display of progress toward healthy lifestyle behaviors and achievement of healthy goals.  The intensive follow up group will be encouraged to wear a biometric sensewear device (armband or vest) for at least one week out of four to record useful biological data to record activity levels and exercise intensity, calories burned, as well as sleep health.  These data will be down loaded periodically for development of reports to the health coaches who will sift the information for progress or difficulties with staying on track.  Using a set of guidelines, health coaches will offer support to the participants when "red flag" alerts arise and can provide more routine email and phone call supportive messages to encourage successful participants.  Through the e3PHR, participants will be offered a website with the capacity to record a journal and to be part of a chat room.  This website resource could function as a war story blog site with a therapeutic, cathartic effect for some.

Reassessments of patients and controls would be scheduled at 6 month intervals for five years.  The reassessments would be comprised of health assessment surveys, biometric data from biometric devices, clinical evaluations including anthropometric data, specialized laboratory data, and CIMT.