Implementing Remote Patient Monitoring to Improve Hypertension Control in a Primary Care Network

实施远程患者监测以改善初级保健网络中的高血压控制

基本信息

项目摘要

SUMMARY Based on evidence from multiple systematic reviews, hypertension guidelines strongly recommend that hypertensive patients measure their blood pressure (BP) at home as an approach to improving BP control so long as this self-measured BP monitoring (SMBP) is conducted with clinical support (i.e., Supported SMBP). Pragmatic trials demonstrate that Supported SMBP increases opportunities for medication titrations, increases BP medication regimen intensity and adherence, and ultimately, improves BP control. Yet, few health systems are systematically implementing Supported SMBP, and less than 20% of hypertensive patients routinely measure their BP at home, resulting in a gap in the translation of evidence-based recommendations into practice. This gap is driven by lack of knowledge regarding how best to implement Supported SMBP to maximize uptake by patients and providers at an acceptable health system cost. In partnership with leaders at New York-Presbyterian (NYP), we developed a nurse-supported SMBP intervention in which a centralized team of nurses is responsible for engaging patients in SMBP, monitoring SMBP data, and providing feedback on HTN control to patients and providers . We next followed a theory- driven process (the Behavior Change Wheel) to select an implementation strategy aimed at increasing uptake of Supported SMBP. We identified telemonitoring as a key implementation strategy. We then pilot tested this intervention and implementation strategy at one clinic and found moderate uptake and promising trends in BP control, but there was still a need to improve the implementation strategy. Few if any studies have assessed the systematic implementation of Supported SMBP in primary care, particularly in low-income settings. We now propose to apply human-centered design to refine our implementation strategy, and then implement and evaluate the Supported SMBP intervention across a primary care network (12 clinics) that provides care to socioeconomically diverse patients (27,600 HTN patients, 35% with uncontrolled BP). We will evaluate the program by conducting a parallel-group cluster randomized trial in which clinics will be randomly assigned to early (intervention) versus delayed (wait-list control) implementation of the telemonitoring-enabled, nurse- supported SMBP intervention. The primary clinical effectiveness outcome will be pre-to-post implementation change in the clinic mean of patients' last systolic BP during a 12-month calendar period. The impact of the implementation strategy will be assessed by measuring uptake of Supported SMBP by patients and providers and by interviewing patients and providers to assess key implementation outcomes (acceptability, fidelity). To inform dissemination, the cost-effectiveness of the intervention from a health system and total healthcare cost perspective will also be assessed. If successful, our project will provide a roadmap for widely implementing SMBP, and will accelerate a change in the paradigm of hypertension management from the clinic to the home.
总结

项目成果

期刊论文数量(0)
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会议论文数量(0)
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Ian Matthew Kronish其他文献

IMPACT OF PRIOR AUTHORIZATION REQUIREMENTS ON PRESCRIPTION FILL PATTERNS AMONG PATIENTS WITH HEART FAILURE
事先授权要求对心力衰竭患者处方填充模式的影响
  • DOI:
    10.1016/s0735-1097(25)01645-6
  • 发表时间:
    2025-04-01
  • 期刊:
  • 影响因子:
    22.300
  • 作者:
    Amrita Mukhopadhyay;Xiyue Li;Carine Hamo;Ian Matthew Kronish;Rumi Chunara;Tyrel Stokes;Nathalia Ladino;Harmony R. Reynolds;John A. Dodson;Stuart Katz;Samrachana Adhikari;Saul Blecker
  • 通讯作者:
    Saul Blecker
NEIGHBORHOOD-LEVEL SOCIOECONOMIC STATUS AND PRESCRIPTION FILL PATTERNS FOR GUIDELINE DIRECTED MEDICAL THERAPY AMONG PATIENTS WITH HEART FAILURE
  • DOI:
    10.1016/s0735-1097(23)00719-2
  • 发表时间:
    2023-03-07
  • 期刊:
  • 影响因子:
  • 作者:
    Amrita Mukhopadhyay;Saul Blecker;Xiyue Li;Ian Matthew Kronish;John A. Dodson;Steven Lawrence;Yaugang Zheng;Sam Kozloff;Rumi Chunara;Samrachana Adhikari
  • 通讯作者:
    Samrachana Adhikari

Ian Matthew Kronish的其他文献

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{{ truncateString('Ian Matthew Kronish', 18)}}的其他基金

Advancing Behavioral Interventions Throughout the Life Course
在整个生命过程中推进行为干预
  • 批准号:
    10683575
  • 财政年份:
    2023
  • 资助金额:
    $ 71.6万
  • 项目类别:
Implementing Remote Patient Monitoring to Improve Hypertension Control in a Primary Care Network
实施远程患者监测以改善初级保健网络中的高血压控制
  • 批准号:
    10649460
  • 财政年份:
    2021
  • 资助金额:
    $ 71.6万
  • 项目类别:
Columbia Roybal Center for Fearless Behavior Change
哥伦比亚皇家无所畏惧行为改变中心
  • 批准号:
    10678853
  • 财政年份:
    2019
  • 资助金额:
    $ 71.6万
  • 项目类别:
Pilot Core
试点核心
  • 批准号:
    10017860
  • 财政年份:
    2019
  • 资助金额:
    $ 71.6万
  • 项目类别:
Pilot Core
试点核心
  • 批准号:
    9810834
  • 财政年份:
    2019
  • 资助金额:
    $ 71.6万
  • 项目类别:
Columbia Roybal Center for Fearless Behavior Change
哥伦比亚皇家无所畏惧行为改变中心
  • 批准号:
    10252886
  • 财政年份:
    2019
  • 资助金额:
    $ 71.6万
  • 项目类别:
Columbia Roybal Center for Fearless Behavior Change
哥伦比亚皇家无所畏惧行为改变中心
  • 批准号:
    10471320
  • 财政年份:
    2019
  • 资助金额:
    $ 71.6万
  • 项目类别:
Pilot Core
试点核心
  • 批准号:
    10678856
  • 财政年份:
    2019
  • 资助金额:
    $ 71.6万
  • 项目类别:
Pilot Core
试点核心
  • 批准号:
    10252888
  • 财政年份:
    2019
  • 资助金额:
    $ 71.6万
  • 项目类别:
Columbia Roybal Center for Fearless Behavior Change
哥伦比亚皇家无所畏惧行为改变中心
  • 批准号:
    10017831
  • 财政年份:
    2019
  • 资助金额:
    $ 71.6万
  • 项目类别:

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