Remote monitoring for Equity in Advancing Control of Hypertension (REACH)

项目概要/摘要 本NHLBI R 01提案旨在启动一项有效性-实施混合随机试验，以适应 多方面的高血压（HTN）管理计划显示在综合医疗保健服务中起作用 安全网医疗保健系统（旧金山弗朗西斯科健康网络）。众所周知，种族/族裔 少数民族和社会经济背景较低的人更有可能被诊断为 HTN以及更有可能有不受控制的高血压。为了改善HTN控制-特别是在 2019冠状病毒病大流行及以后-需要更多的患者参与自我管理， 日常生活，以及改善患者与临床医生关于家庭血压（BP）读数的沟通 和抗高血压药物的潜在变化。先前的试验表明，数字技术， 特别是家庭BP监测与增强的数字患者-提供者通信相结合， 改善血压控制--这对于在大流行期间对所有患者进行远程血压管理至关重要。 然而，传播这些已知的最佳做法已被证明具有挑战性，特别是在安全网方面 为慢性病负担最重的患者提供服务的医疗机构。 尽管人们对使用数字医疗保健通信工具的兴趣很高，但脆弱的患者群体 目前不太可能使用家庭BP监测设备和现有的门户网站与他们的 医疗保健提供者和团队。因此，医患沟通干预措施必须包括 培训/支持和患者激活是适应基于数字的家庭BP的重要组成部分 管理方案纳入安全网。 在本研究的目标1中，我们将为未受控制的HTN患者提供面对面培训，以支持他们使用 家庭血压监测仪、在线患者门户网站以及短信和移动的电话应用程序的基础知识。 我们将检查培训前后技术使用的总体变化，以及特定患者亚组的变化 在技术吸收方面存在已知的差异。在目标2中，我们将进行一项双臂随机临床试验， 评估增强的数字通信（短信提醒/支持和门户网站）的有效性 消息传递以制定行动计划并远程调整抗高血压药物）与常规护理。两 各组将接受智能家庭BP监测仪，主要结局将是12个月时的BP控制。在Aim中 3.我们将在RE-AIM的指导下，采用混合方法评估主要实施成果 框架，适应现有的，以证据为基础的远程BP监测计划。

ProjectSummary/Abstract This NHLBI R01 proposal aims to launch an effectiveness-implementation hybrid randomized trial to adapt a multi-faceted hypertension (HTN) management program shown to work in integrated healthcare delivery systems to a safety net healthcare system (San Francisco Health Network). It is well known that racial/ethnic minorities and those from lower socioeconomic backgrounds are significantly more likely to be diagnosed with HTN as well as more likely to have uncontrolled hypertension. To improve HTN control – particularly during the COVID-19 pandemic and beyond – there is a need for greater patient engagement in self-management in everyday life, as well as improved patient-clinician communication about home blood pressure (BP) readings and potential changes in anti-hypertensive medications. Previous trials have shown that digital technologies, specifically home BP monitoring combined with enhanced digital patient-provider communication, significantly improve BP control -- and these are critical for remote BP management for all patients during the pandemic. However, disseminating these known best practices has proved challenging, particularly in safety net healthcare settings that serve patients with the highest burden of chronic illness. Despite high interest in using tools for digital healthcare communication, vulnerable patient populations are currently less likely to use home BP monitoring devices and existing portal websites to communicate with their healthcare providers and teams. Therefore, patient-provider communication interventions must include training/support and patient activation as essential components of adapting digitally-based home BP management programs into the safety net. In Aim 1 of this study, we will offer patients with uncontrolled HTN in-person training to support their use of home BP monitors, the online patient portal, and basics about text messaging and mobile phone applications. We will examine pre-post training changes in technology use overall, as well as by specific patient subgroups with known differences in technology uptake. In Aim 2 we will conduct a two-arm randomized clinical trial to assess the effectiveness of enhanced digital communication (text messaging to remind/support and portal messaging to develop action plans and remotely adjust anti-hypertensive medications) vs. usual care. Both groups will receive a smart home BP monitor, and the primary outcome will be BP control at 12 months. In Aim 3 we will use a mixed methods approach to evaluate key implementation outcomes, guided by the RE-AIM framework, of adapting this existing, evidence-based remote BP monitoring program.