Improving Coronary Prevention in a County Health System

改善县卫生系统的冠心病预防

• 批准号: 6612014
• 负责人: RANDALL SCOTT STAFFORD
• 金额: $ 63.77万
• 依托单位: STANFORD UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2003
• 资助国家: 美国
• 起止时间: 2003-04-01 至 2007-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6612014
• 关键词: cardiovascular disorder prevention; cardiovascular disorder risk; clinical research; community health services; coronary disorder; cost effectiveness; health care cost /financing; health economics; human morbidity; human mortality; human subject; longitudinal human study; patient care management; patient oriented research; socioeconomics

DESCRIPTION (provided by applicant): Evidence from extensive population studies and clinical trials shows the effectiveness of risk factor management in reducing morbidity and mortality from coronary artery disease (CAD). These studies have generated important national clinical practice guidelines. Current prevention practices, however, fall short of attaining the goals recommended in these national guidelines. These shortfalls lead to unnecessary CAD disease burden, as well as perpetuation of socioeconomic disparities. Case management proves to augment current CAD prevention activities and improve adherence with national guidelines. The Stanford Health Education and Risk Reduction Training (HEAR2T) program is an innovative, yet well-tested, case management tool. By rigorously evaluating HEAR2T in a high-risk population of low socioeconomic status (SES) served by the county health care system of San Mateo County (SMC), CA, this study will: 1) enhance the HEAR2T program for use in Iow-SES populations; 2) implement this program as an integral part of clinical care; 3) implement a randomized controlled trial to evaluate the effectiveness of HEAR2T in lowering aggregate CAD risk; 4) determine if HEAR2T diminishes socioeconomic disparities; 5) estimate HEAR2T's cost effectiveness; and 6) transition the intervention from a research study to an ongoing County CAD case management program. Our primary outcome measure will be change in aggregate CAD risk score, calculated from a Framingham model based on individual CAD risk factors. Our primary hypothesis is that patients case-management via the HEAR2T model will produce favorable changes in aggregate CAD risk score compared to control patients in usual care. We will enroll 200 intervention and 200 usual care patients from four health centers in the SMC system. Usual care patients will crossover to the intervention after 15 months, allowing for additional assessment of the intervention's impact. Continued follow-up of the participants will assess the durability of risk changes achieved during initial intensive case-management. This study will make a critical and innovative contribution to defining optimal disease management in a Iow-SES population. In so doing, we will aid broader national efforts seeking to reap the societal "return on investment" available from evidence-based prevention.

描述（由申请人提供）：来自广泛人群研究和临床试验的证据表明，风险因素管理在降低冠状动脉疾病（CAD）发病率和死亡率方面的有效性。这些研究产生了重要的国家临床实践指南。然而，目前的预防做法未能达到这些国家指南中建议的目标。这些不足导致不必要的CAD疾病负担，以及社会经济差距的延续。病例管理被证明可以加强目前的CAD预防活动，并改善对国家指导方针的遵守。斯坦福健康教育和降低风险培训（HEAR2T）项目是一个创新的、经过良好测试的病例管理工具。通过严格评估加州圣马特奥县（SMC）县卫生保健系统服务的低社会经济地位（SES）高危人群的HEAR2T，本研究将：1)加强低社会经济地位人群的HEAR2T计划；2)将该方案作为临床护理的一个组成部分实施；3)实施一项随机对照试验，评估HEAR2T降低冠心病总风险的有效性；4)确定HEAR2T是否会缩小社会经济差异；5)评估HEAR2T的成本效益；6)将干预从研究性研究转变为正在进行的县CAD病例管理计划。我们的主要结果测量将是CAD总风险评分的变化，该评分由基于个体CAD风险因素的Framingham模型计算得出。我们的主要假设是，与常规护理的对照患者相比，通过HEAR2T模型进行患者病例管理将产生CAD总风险评分的有利变化。我们将从SMC系统的四个卫生中心招募200名干预和200名常规护理患者。常规护理患者将在15个月后转为干预，允许对干预的影响进行额外评估。参与者的持续随访将评估在最初的密集病例管理期间实现的风险变化的持久性。这项研究将为定义低社会经济地位人群的最佳疾病管理做出关键和创新的贡献。在这样做的过程中，我们将帮助更广泛的国家努力，寻求从循证预防中获得社会“投资回报”。