Feasibility of a Web-based Collaborative Care Support(SM)Model to Improve Care fo

基于网络的协作护理支持（SM）模型改善护理的可行性

• 批准号: 7803934
• 负责人: Jan Swaney
• 金额: $ 21.39万
• 依托单位: LONGITUDE HEALTH, INC.
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-05-01 至 2011-12-01
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7803934
• 关键词: Accounting; Address; Adherence; Adopted; Adult; Behavior Therapy; Behavioral; Cardiovascular system; Caring; Chronic; Chronic Disease; Client satisfaction; Communication; Comorbidity; Complex; Complications of Diabetes Mellitus; Coupled; Data; Data Collection; Death Certificates; Diabetes Mellitus; Diagnosis; Disease Management; Education; Enrollment; Ensure; Environment; Expenditure; Funding; Health; Health Expenditures; Healthcare; Hyperlipidemia; Hypertension; Intervention; Medical; Methodology; Modeling; Morbidity - disease rate; Non-Insulin-Dependent Diabetes Mellitus; Online Systems; Patient Care; Patients; Premature Mortality; Preventive; Primary Health Care; Process; Process Assessment; Provider; Quality of Care; Risk Factors; Risk Reduction; Self Management; Services; Smoking; Staging; System; Testing; Time; United States; Work; base; cardiovascular risk factor; care systems; chronic care model; collaborative care; cost; disability; empowered; evidence base; hypertensive heart disease; improved; innovation; intervention effect; meetings; mortality; patient oriented; population health; programs; public health relevance; satisfaction; success

DESCRIPTION (provided by applicant): Diabetes costs the United States an estimated $174 billion annually. About two-thirds of costs arise from direct medical expenditures, and the remainder accrues from disability, work loss, and premature mortality. Associated cardiovascular comorbidities result in further mortality and morbidity; seventy-five percent (75%) of patients with diabetes also have hypertension, and heart disease is a contributing cause on 68% of diabetes-related death certificates. The cardiovascular complications of diabetes can be significantly reduced with appropriate lifestyle modification and primary and secondary preventive care; yet in the current practice environment, primary care providers find it difficult to deliver the comprehensive education and behavioral support needed to ensure adequate risk factor reduction. If patients are to receive better quality of care for this complex, chronic disease, then a model of planned care that better supports behavioral approaches to risk reduction and is integrated with the primary care practice workflow is needed. We propose to test the feasibility of Collaborative Care SupportSM (CCS), a web-based communication platform coupled with personal health guidance that enrolls adult patients who have type 2 diabetes and at least one other cardiovascular risk factor (hypertension, hyperlipidemia, and/or smoking) in a collaborative, patient-centered, behaviorally-based intervention that integrates with primary care provider workflows to improve patient activation. Previous attempts to empower patients have included disease management and self-management support, but these programs do not involve the primary care provider and are not accessible to many because of limitations their limited availability.. Because it is important that fragmented care is replaced by planned and coordinated care where possible, CCS is likely to meet with more success than traditional disease management and self-management support.

描述（由申请人提供）：糖尿病每年花费美国估计1740亿美元。大约三分之二的费用来自直接医疗支出，其余的来自残疾、失业和过早死亡。相关的心血管合并症导致进一步的死亡率和发病率; 75%的糖尿病患者还患有高血压，心脏病是68%的糖尿病相关死亡证明的促成原因。糖尿病的心血管并发症可以通过适当的生活方式改变和初级和二级预防保健显着减少;然而，在目前的实践环境中，初级保健提供者发现很难提供全面的教育和行为支持，以确保充分的风险因素减少。如果患者要接受更好的护理质量，这种复杂的慢性疾病，那么一个有计划的护理模式，更好地支持行为的方法来降低风险，并与初级保健实践的工作流程是必要的。我们建议测试协作护理支持SM（CCS）的可行性，CCS是一个基于网络的通信平台，结合个人健康指导，招募患有2型糖尿病和至少一种其他心血管危险因素（高血压，高血脂和/或吸烟）的成年患者，以患者为中心，以行为为基础的协作干预，与初级保健提供者的工作流程相结合，以提高患者的激活。以前尝试赋予患者权力包括疾病管理和自我管理支持，但这些计划不涉及初级保健提供者，并且由于其有限的可用性，许多人无法获得。由于在可能的情况下用有计划和协调的护理取代分散的护理是很重要的，CCS可能比传统的疾病管理和自我管理支持更成功。