Home Blood Pressure Telemonitoring and Case Management to Control Hypertension

家庭血压远程监测和病例管理以控制高血压

• 批准号: 8122236
• 负责人: KAREN L MARGOLIS
• 金额: $ 40.88万
• 依托单位: HEALTHPARTNERS INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-09-15 至 2013-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8122236
• 关键词: Address; Adult; Agreement; American; Antihypertensive Agents; Blinded; Blood Pressure; Cardiovascular system; Caring; Case Management; Case Manager; Chronic; Client satisfaction; Clinic; Clinical; Communication; Computerized Medical Record; Control Groups; Data; Diabetes Mellitus; Education; Enrollment; Ensure; Equipment; Event; Formularies; Future; Goals; Guidelines; Health; Home environment; Hypertension; Information Systems; Intervention; Kidney Diseases; Length; Maintenance; Measurement; Measures; Medical; Methods; Modeling; Modems; Office Visits; Outcome; Patients; Performance; Pharmaceutical Preparations; Pharmacists; Phase; Physicians; Population Heterogeneity; Primary Health Care; Problem Solving; Process; Protocols documentation; Randomized; Randomized Controlled Trials; Reading; Research; Research Design; Secure; Self Management; Telephone; Testing; Therapeutic; Therapeutic Intervention; Time; Touch sensation; Visit; Writing; base; blood pressure regulation; care systems; chronic care model; cost; effective intervention; empowered; follow-up; hypertension control; hypertension treatment; improved; innovation; multi-component intervention; new technology; patient population; population based; prevent; primary care setting; randomized trial; satisfaction; social; technological innovation; treatment as usual; web site

DESCRIPTION (provided by applicant): Blood pressure (BP) is controlled to recommended levels in only 1 in 3 people with hypertension, and there has been little improvement since the late 1980s, despite advances in evidence to support aggressive hypertension control, and availability of many new and effective antihypertensive drugs. It is clear that meaningful and sustained improvement in hypertension control will likely require fundamental changes in the current physician-centered office-visit based model of caring for hypertension. In this project we develop and implement an intervention that takes advantage of new technology and team models of care to improve BP measurement and control, solving the problems that have limited the application of case management approaches to hypertension care improvement. The study will take place in a diverse population of adults with hypertension cared for in a real-world primary care setting. The Telemonitoring Intervention (TI) integrates 2 innovative components: First, home BP measures are done using state-of-the-art modem-enabled automated equipment that internally stores and electronically transmits BP data through a simple touch-tone telephone connection to a secure web site. Second, a pharmacist case manager integrated with the primary care team through a jointly used electronic medical record (EMR) and formulary adjusts antihypertensive therapy using an approved written protocol, under a collaborative practice agreement with physicians. Treatment decisions are based on home BP data and are discussed and communicated to patients in telephone visits with the pharmacist case manager. Two-way communication between the pharmacist case manager and the patient's primary care team is assured by using a shared EMR and by additional secure messaging of the results of every pharmacist encounter to the primary care team. To assess the impact of the TI on hypertension control, patient satisfaction, and costs of care, we will conduct a cluster-randomized trial, assigning 16 primary care clinics and 450 of their nested patients with uncontrolled hypertension to either a Usual Care (UC) control group or TI. Blood pressure outcomes in both groups will be determined at baseline, 6, 12 and 18 months in an identical and blinded fashion in a research clinic separate from the clinical setting where patients received their medical care. We hypothesize that guideline BP control will be achieved at 6 months and maintained at 12 months in more than 60% of patients from TI clinics, compared to < 40% in patients from UC clinics. We will compare satisfaction with care and costs in the TI and UC groups. The TI has the potential to improve hypertension control for millions of patients, and could be implemented widely in diverse and large patient populations based on performance in this randomized trial. The results of the project will have important implications for future efforts to improve care provided to many of the estimated 20 million Americans with uncontrolled hypertension. PUBLIC HEALTH RELEVANCE: In this project we develop and implement an intervention to improve hypertension control in a primary care setting that takes advantage of new technology (home blood pressure telemonitoring) and team models of care (pharmacist case management). The results of the project will have important implications for future efforts to improve care provided to many of the estimated 20 million Americans with uncontrolled hypertension.

描述（由申请人提供）：只有三分之一的高血压患者的血压（BP）控制在推荐水平，自20世纪80年代末以来，尽管有证据支持积极的高血压控制，并且许多新的有效的抗高血压药物可用，但几乎没有改善。很明显，高血压控制的有意义的和持续的改善可能需要从根本上改变目前以医生为中心的办公室访问为基础的高血压护理模式。在这个项目中，我们开发并实施了一种干预措施，利用新技术和团队护理模式来改善BP测量和控制，解决了限制病例管理方法应用于高血压护理改善的问题。该研究将在现实世界初级保健环境中接受高血压治疗的不同成人人群中进行。远程监护干预（TI）集成了2个创新组件：首先，家庭BP测量是使用最先进的调制解调器启用自动化设备，内部存储和电子传输BP数据通过一个简单的按键式电话连接到一个安全的网站。第二，药剂师病例管理员通过联合使用的电子病历（EMR）和处方集与初级保健团队整合，根据与医生的合作实践协议，使用批准的书面协议调整抗高血压治疗。治疗决策基于家庭BP数据，并与药剂师病例经理进行讨论并通过电话访视与患者沟通。通过使用共享的EMR以及将每次药剂师会面的结果附加安全消息传递给初级保健团队，确保药剂师病例管理器和患者初级保健团队之间的双向通信。为了评估TI对高血压控制、患者满意度和护理成本的影响，我们将进行一项随机分组试验，将16个初级保健诊所和450名嵌套的高血压控制不佳的患者分配到社区护理（UC）对照组或TI组。两组的血压结局将在基线、6、12和18个月时在与患者接受医疗护理的临床环境分开的研究诊所以相同的设盲方式确定。我们假设，TI诊所60%以上的患者在6个月时达到指南血压控制，12个月时维持，而UC诊所< 40%的患者。我们将比较TI组和UC组对护理和费用的满意度。TI有可能改善数百万患者的高血压控制，并可根据本随机试验的性能在不同的大型患者人群中广泛实施。该项目的结果将对未来努力改善为估计2000万美国人中的许多人提供的护理产生重要影响。公共卫生关系：在这个项目中，我们开发并实施了一种干预措施，以改善初级保健环境中的高血压控制，利用新技术（家庭血压远程监测）和团队护理模式（药剂师病例管理）。该项目的结果将对未来努力改善为估计2000万美国人中的许多人提供的护理产生重要影响。