Hypertension Telemanagement in African Americans

非裔美国人的高血压远程管理

• 批准号: 7216079
• 负责人: JOSEPH E FINKELSTEIN
• 金额: $ 7.43万
• 依托单位: UNIVERSITY OF MARYLAND BALTIMORE
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-09-30 至 2009-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7216079
• 关键词: African American; behavioral /social science research tag; cardiovascular disorder education; clinical research; cognitive behavior therapy; computer assisted patient care; computer human interaction; cost effectiveness; health behavior; health care personnel performance; health care service evaluation; health care service utilization; health services research tag; human subject; hypertension; lifestyle; patient care management; patient care personnel relations; patient monitoring device; self care; social support network; telemedicine; therapy compliance

DESCRIPTION (provided by applicant): Studies employing telecommunication technologies have been successful in affecting the major components of chronic disease care including physician practice patterns, patient adherence to therapy, and patient-provider communication. To date there have been no studies evaluating a coordinated approach that simultaneously employs all of these components in an integrated framework linked to primary care practices. In this study we propose to evaluate a multicomponent telemanagement system providing an integrated support both to clinicians and patients in following hypertension treatment guidelines promulgated by JNC 7 Report. The Internet-based Home Automated Telemanagement (HAT) system implements a multi-component chronic disease management model which includes regular patient assessment, disease-specific education, control of patient adherence to treatment plans, promotion of therapeutic lifestyle changes, comprehensive patient-provider communication and computerized decision support. In this proposal we will (1) refine the HAT System to fully implement the multidisciplinary model for telemanagement of hypertension in African Americans (2) evaluate in a randomized controlled trial the magnitude of clinical impact of HAT on hypertension control rates in African Americans and examine cost-effectiveness of the proposed approach. Patients will have the HAT units (Internet-enabled computer connected to a blood pressure monitor and weight scale) installed in their homes and will be instructed how to use it. They will be asked to do self-testing on a regular basis and to answer questions on their computer screen (symptoms, medication use, and other self-care actions). Each HAT session will include (1) patient assessment (objective measurements such as blood pressure and body weight, which are automatically downloaded to the computer, and patient-reported parameters such as patient symptoms and medication use), (2) interpretation and advice according to individualized treatment plan generated by patient's physician, (3) structured hypertension education, (4) patient counseling and health behavior adjustment (based on main constructs of Social Cognitive Theory, such as behavioral capability, self-efficacy, outcome expectations and reinforcement), (5) social support (virtual patient groups, communication with social worker),. Overall, 550 African Americans with hypertension will be enrolled from 50 primary care clinics and will be followed for 18 months. The main study outcomes will be proportion of treated patients that achieve blood pressure goals meeting JNC 7 recommendations, and mean change in systolic and diastolic pressure. We will also explore HAT impact on physician awareness and adherence to JNC 7 guidelines, and patient ability to reach lifestyle modification goals recommended by the JNC 7 Report. Finally, we will perform cost-effectiveness analysis of the HAT intervention in the African American patients with hypertension.

描述（由申请人提供）： 采用电信技术的研究已经成功地影响了慢性病护理的主要组成部分，包括医生的实践模式，患者对治疗的依从性，以及患者与提供者的沟通。 到目前为止，还没有研究评估一个协调的方法，同时采用所有这些组成部分在一个综合框架联系到初级保健做法。在这项研究中，我们建议评估一个多组件远程管理系统提供了一个综合的支持，临床医生和患者在以下高血压治疗指南颁布的JNC 7报告。以互联网为基础的家庭自动化远程管理系统实施了一个多组成部分的慢性病管理模式，包括定期对病人进行评估、针对具体疾病的教育、控制病人遵守治疗计划、促进治疗生活方式的改变、全面的病人与提供者沟通以及计算机化的决策支持。在本提案中，我们将（1）完善HAT系统，以全面实施非裔美国人高血压远程管理的多学科模型（2）在一项随机对照试验中评估HAT对非裔美国人高血压控制率的临床影响程度，并检查所提出方法的成本效益。患者将在家中安装HAT装置（连接到血压监测器和体重计的互联网计算机），并指导如何使用它。他们将被要求定期进行自我测试，并在计算机屏幕上回答问题（症状，药物使用和其他自我护理行动）。每次HAT会议将包括（1）患者评估（自动下载到计算机上的诸如血压和体重之类的客观测量，以及诸如患者症状和药物使用之类的患者报告的参数），（2）根据患者的医生生成的个性化治疗计划的解释和建议，（3）结构化的高血压教育，（4）患者咨询和健康行为调整（基于社会认知理论的主要结构，如行为能力、自我效能、结果期望和强化）;（5）社会支持（虚拟患者群体、与社会工作者的沟通）。总体而言，将从50个初级保健诊所招募550名患有高血压的非洲裔美国人，并将随访18个月。主要研究结局将是达到符合JNC 7建议的血压目标的治疗患者比例，以及收缩压和舒张压的平均变化。我们还将探索HAT对医生意识和遵守JNC 7指南的影响，以及患者实现JNC 7报告建议的生活方式改变目标的能力。最后，我们将进行成本效益分析的HAT干预非洲裔美国人高血压患者。