Prospective Cohort Study of Remote Patient Monitoring with and without Care Coordination for Hypertension in Primary Care.
Prospective Cohort Study of Remote Patient Monitoring with and without Care Coordination for Hypertension in Primary Care.
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DOI：
10.1055/a-2057-7277
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发表时间：
2023-05
影响因子：
2.9
通讯作者：
中科院分区：
文献类型：
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作者：
背景：门诊血压（BP）测量为指导高血压的临床管理提供了有价值的信息。 来自家庭设备的测量结果可以直接传输到患者的电子健康记录，用于远程监控程序。 目的本研究旨在比较初级保健实践中护理协调员辅助实施的高血压远程患者监护（RPM）与单独实施RPM和常规护理。 方法本研究是一项实用的观察性队列研究。 纳入了来自两个人群的65至85岁的医疗保险患者：患有不受控制的高血压的患者和在一个卫生系统内看初级保健医生（PCP）的一般高血压组。暴露是RPM加护理协调、单独RPM或常规护理的临床水平可用性。在两个诊所（13个PCP），获得PCP批准的护士护理协调员向办公室血压不受控制的患者提供RPM，并协助启动。在两个诊所（39个PCP），RPM由PCP自行决定。20家诊所继续提供常规护理。主要措施是控制高血压（<140/90 mm Hg），最后办公室收缩压（SBP），并与降压药物强化的比例。 结果在高血压未控制的医疗保险队列中，16.7%（39/234）的护理协调诊所的患者使用RPM，而非护理协调诊所的患者使用RPM的比例<1%（4/600）。 RPM入组的护理协调组患者的基线SBP高于非护理协调组（148.8与140.0 mm Hg）。6个月后，未控制高血压组的高血压控制率为32.5%（RPM与护理协调），30.7%（单独RPM），27.1%（常规治疗）;多变量校正比值比（95%置信区间）分别为1.63（1.12-2.39; p = 0.011）和1.29（0.98-1.69; p = 0.068）。 结论护理协调促进了控制不佳的高血压患者的RPM登记，并可能改善医疗保险患者在初级保健中的高血压控制。
Background Out-of-office blood pressure (BP) measurements contribute valuable information for guiding clinical management of hypertension. Measurements from home devices can be directly transmitted to patients' electronic health record for use in remote monitoring programs. Objective This study aimed to compare in primary care practice care coordinator-assisted implementation of remote patient monitoring (RPM) for hypertension to RPM implementation alone and to usual care. Methods This was a pragmatic observational cohort study. Patients aged 65 to 85 years with Medicare insurance from two populations were included: those with uncontrolled hypertension and a general hypertension group seeing primary care physicians (PCPs) within one health system. Exposures were clinic-level availability of RPM plus care coordination, RPM alone, or usual care. At two clinics (13 PCPs), nurse care coordinators with PCP approval offered RPM to patients with uncontrolled office BP and assisted with initiation. At two clinics (39 PCPs), RPM was at PCPs' discretion. Twenty clinics continued usual care. Main measures were controlling high BP (<140/90 mm Hg), last office systolic blood pressure (SBP), and proportion with antihypertensive medication intensification. Results Among the Medicare cohorts with uncontrolled hypertension, 16.7% (39/234) of patients from the care coordination clinics were prescribed RPM versus <1% (4/600) at noncare coordination sites. RPM-enrolled care coordination group patients had higher baseline SBP than the noncare coordination group (148.8 vs. 140.0 mm Hg). After 6 months, in the uncontrolled hypertension cohorts the prevalences of controlling high BP were 32.5% (RPM with care coordination), 30.7 % (RPM alone), and 27.1% (usual care); multivariable adjusted odds ratios (95% confidence interval) were 1.63 (1.12–2.39; p = 0.011) and 1.29 (0.98–1.69; p = 0.068) compared with usual care, respectively. Conclusion Care coordination facilitated RPM enrollment among poorly controlled hypertension patients and may improve hypertension control in primary care among Medicare patients.
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影响因子：
2.9
作者：
Chi, Wei Ning;Reamer, Courtney;Shah, Nirav S.
通讯作者：
Shah, Nirav S.
影响因子：
120.7
作者：
Green, Beverly B.;Cook, Andrea J.;Thompson, Robert S.
通讯作者：
Thompson, Robert S.
影响因子：
2.1
作者：
Petito LC;Anthony L;Peprah YA;Lee JY;Li J;Sato H;Persell SD
通讯作者：
Persell SD
影响因子：
15.8
作者：
Tucker KL;Sheppard JP;Stevens R;Bosworth HB;Bove A;Bray EP;Earle K;George J;Godwin M;Green BB;Hebert P;Hobbs FDR;Kantola I;Kerry SM;Leiva A;Magid DJ;Mant J;Margolis KL;McKinstry B;McLaughlin MA;Omboni S;Ogedegbe O;Parati G;Qamar N;Tabaei BP;Varis J;Verberk WJ;Wakefield BJ;McManus RJ
通讯作者：
McManus RJ
影响因子：
4.9
作者：
Williams, Bryan;Mancia, Giuseppe;Desormais, Ileana
通讯作者：
Desormais, Ileana