Web-based, Patient-centered Approach to CVD Risk-factor Management and Reduction

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DESCRIPTION (provided by applicant): Cardiovascular disease (CVD) is a leading cause of mortality and morbidity in American Indians (Als). While the presence of type 2 diabetes, with its many behavioral antecedents, constitutes a significant portion of the CVD risk in this population, there have been few behaviorally-based interventions among American Indians intended to lessen this CVD risk. Poor dietary and physical activity habits and adherence with prescribed therapies and instructions for chronic disease management are several important behaviors that can place an individual at increased risk of CVD and, in turn, possibly be amenable to a cognitive intervention. Innovations in home-based care are emerging to create a new paradigm for chronic disease management. The Institute of Medicine's report, "Crossing the Quality Chasm," has recommended a shift from care based primarily on sporadic office visits toward "care based on continuous healing relationships ... not just face-to-face visits". We feel it warranted to test some of these new home-based, cognitive strategies for cardiovascular disease prevention among American Indians. Therefore, the Specific Aims of this project are to: 1. Implement a Social Cognitive Theory-, home-based, remote care approach to improve the adherence of a cohort of American Indians, free of but at high risk for CVD, with prescribed physiologic therapies and behavioral instructions they have been given to manage, respectively, their diagnosed hypertension, hypercholesterolemia, and diabetes; 2. Improve the adherence of these cohort members with behavioral lifestyle antecedents such as diet, exercise, and smoking, that impact the physiologic conditions described in Aim #1 and, hence, CVD risk; 3. Provide these American Indian study participants with a culturally-tailored, home health-based chronic disease management program, coupled with the requisite hardware, software, training and staffing, that will supplement in a paradigm-changing way the route in which they presently receive care; and 4. Document the cost-effectiveness of this intervention by documenting all program costs per patient served; the cost per change in specified outcome measures if the program is found to be effective; and a comparison of the intervention costs to those of other comparable programs and strategies employed within the IHS to improve diabetes self-management and prevent the onset of CVD. We believe there are few issues in healthcare as rapidly emerging as chronic disease management and the role that home-based care might play, including cardiovascular disease prevention. By the year 2030, fully half of the US adult population will be both chronically diseased and wired. The epidemiology of American Indian health has already transitioned from a model of infectious disease to one of chronic disease. This unique intervention, if proven effective, will serve as a model for home-based care and cardiovascular disease prevention in many other rural settings, both Indian and non-Indian.