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

远程监控促进高血压控制的公平性 (REACH)

基本信息

批准号：
10491102
负责人：
COURTNEY REES LYLES
金额：
$ 72.55万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-09-20 至 2023-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10491102
关键词：
Adoption African American population American Antihypertensive Agents Blood Pressure Blood Pressure Monitors COVID-19 COVID-19 pandemic Car Phone Caring Chronic Disease Clinic Clinical Clinical Pharmacists Communication Data Diagnosis Electronic Health Record Ethnic Origin Goals Health Health Personnel Healthcare Systems Heart Home Home Blood Pressure Monitoring Hypertension Income Infrastructure Integrated Delivery Systems Integrated Delivery of Health Care Intervention Latinx population Life Limited English Proficiency Literature Low income Maintenance Measurement Measures Medical Care Team Medical Records Methods Monitor Myocardial Infarction National Heart, Lung, and Blood Institute Outcome Patients Persons Pharmaceutical Preparations Population Heterogeneity Primary Health Care Protocols documentation Provider Randomized Randomized Clinical Trials Reach Effectiveness Adoption Implementation and Maintenance Reading San Francisco Secure Self Management Site Stroke System Technology Text Text Messaging Time TimeLine Training Training Support Visit Work arm base blood pressure control cost digital digital communication digital healthcare effectiveness evaluation effectiveness implementation study ethnic minority evidence base health care availability health care settings hypertension control implementation outcomes improved interest literacy monitoring device pandemic disease patient engagement patient population patient portal patient subsets patient-clinician communication primary outcome programs racial and ethnic racial disparity randomized trial remote health care remote intervention remote monitoring safety net skills smart home socioeconomics standard care tailored messaging technology training telehealth tool treatment as usual uptake web portal web site wireless

项目摘要

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.

项目摘要/摘要该NHLBI R01提案旨在启动有效性实施混合随机试验以适应显示在综合医疗保健交付中工作的多面高血压（HTN）管理计划安全网医疗系统（旧金山健康网络）的系统。众所周知，种族/民族少数民族和来自较低社会经济背景的人更有可能被诊断出患有 HTN，更有可能患有不受控制的高血压。为了改善HTN的控制 - 特别是在 COVID-19-19大流行及以后 - 需要更大的患者参与自我管理日常生活以及改善有关家庭血压（BP）读数的患者阵容沟通以及抗高血压药物的潜在变化。以前的试验表明，数字技术，特别是Home BP监控与增强的数字患者提供沟通相结合，显着改善BP控制 - 这些对于所有患者在大流行期间的远程BP管理至关重要。但是，传播这些已知最佳实践已被证明是挑战，尤其是在安全网中为慢性病烧伤最高的患者提供服务的医疗保健环境。尽管对使用工具进行数字医疗通信的兴趣很高，但脆弱的患者人群是目前不太可能使用家庭BP监视设备和现有门户网站与他们的交流医疗保健提供者和团队。因此，必须包括患者的沟通干预措施培训/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程序进入安全网。在本研究的AIM 1中，我们将为接受不受控制的HTN亲自培训的患者提供支持家庭BP监视器，在线患者门户以及有关文本消息和手机应用程序的基础知识。我们将检查整体技术使用的前培训变化以及特定的患者子组技术吸收有已知差异。在AIM 2中，我们将进行两臂随机临床试验评估增强数字通信的有效性（提醒/支持和门户网站的文本消息传递介绍行动计划并远程调整抗高血压药物的消息传递）与通常的护理。两个都小组将收到一个智能的Home BP监视器，主要结果将在12个月时控制BP。目标 3我们将使用混合方法来评估主要实施结果，在RE-AIM的指导下框架，以适应现有的基于证据的远程BP监视程序。