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

项目摘要/摘要 这项NHLBI R01提案旨在启动有效性-实施混合随机试验，以适应 多方面的高血压(HTN)管理计划在综合医疗保健服务中发挥作用 系统连接到安全网医疗系统(旧金山医疗网络)。众所周知，种族/民族 少数族裔和社会经济背景较低的人更有可能被诊断为 HTN以及更有可能出现无法控制的高血压。改善对HTN的控制-特别是在 新冠肺炎大流行及以后-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之间关于家庭血压(BP)读数的沟通 以及抗高血压药物的潜在变化。之前的试验表明，数字技术， 尤其是家庭血压监测与增强的数字患者-提供者通信相结合，显著 改善BP控制--这对于在大流行期间对所有患者进行远程BP管理至关重要。 然而，事实证明，传播这些已知的最佳做法具有挑战性，特别是在安全网中。 为慢性病负担最重的患者提供服务的医疗保健设置。 尽管人们对使用工具进行数字医疗通信非常感兴趣，但脆弱的患者群体 目前不太可能使用家用BP监测设备和现有门户网站与他们的 医疗保健提供者和团队。因此，患者与提供者之间的沟通干预必须包括 培训/支持和患者激活作为适应基于数字的家庭BP的基本组成部分 将管理方案纳入安全网。 在这项研究的目标1中，我们将为患有无控制HTN的患者提供面对面的培训，以支持他们使用 Home BP监护仪，在线患者门户网站，以及短信和移动电话应用的基础知识。 我们将检查培训前技术使用的总体变化，以及特定患者分组的变化 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的有效性(用于提醒/支持和门户的短信 制定行动计划和远程调整抗高血压药物的消息传递)与常规护理。两者都有 小组将接受智能家居BP监测器，主要结果将是在12个月时控制BP。在AIM 3我们将在RE-AIM的指导下，使用混合方法来评估关键的实施成果 框架，以适应这一现有的、基于证据的远程BP监测程序。

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.