Nurse Management of Hypertension in Rural Western Kenya

项目总结：肯尼亚西部农村高血压的护士管理 心血管疾病(CVD)是撒哈拉以南非洲年龄以上成年人死亡的主要原因 30.高血压是心血管疾病的一个主要危险因素，在撒哈拉以南非洲，高血压的患病率正在随着时间的推移而增加， 给该地区造成重大的流行病和经济负担。如果没有足够的控制 高血压，其健康和经济负担将在未来几十年急剧增加。建立良好的 管理高血压的循证干预措施已经存在。然而，治疗和控制率很低， 由于缺乏有效的慢性病管理平台，获取渠道不足等几个原因 基本药物供应不足，人力资源不足。改善高血压分娩的一种策略 护理是任务转移，具体任务从高素质的卫生工作者“转移”到卫生工作者 培训时间更短，资质更低。因此，该项目的总体目标是利用多个- 在撒哈拉以南非洲优化高血压护理提供的学科实施研究方法， 重点研究高血压护士管理中的任务转移策略。候选人拉杰什博士 韦丹森是西奈山医学院的医学/心脏病学助理教授，他的目标是成为 专门从事实施研究的独立临床调查员，以优化交付 低收入和中等收入国家的心血管预防和治疗干预。他的职业生涯 针对这一职业目标的发展计划包含了一个精心设计的多学科计划 提供紧凑、密切指导的实施研究体验，并与结构化的 说教式课程。候选人将与肯尼亚西部农村合作开展拟议的研究 美国国际开发署--提供医疗服务的学术模式 (AMPATH)伙伴关系。目标1是评估以护士为基础的实施的促进者和障碍 通过实施快速评估程序，对高血压患者进行管理。目标2是利用一个 参与式、迭代、以人为中心的设计流程，以开发基于智能手机的决策支持和 综合记录保存(Desire)工具，供护士用于高血压管理。目标3是 开展以护士为基础的高血压管理试点计划的影响评估 由AMPATH实施。目标4是评估长期稳定的护士劳动力需求 使用基于需求的劳动力估计模型治疗高血压。具体目标将是 在多学科导师和顾问团队的指导下完成，并与 专业知识。该项目以以下职业目标为指导：1)培养定性方法方面的专业知识 和以社区为基础的参与性研究；2)发展管理科学和人文科学的能力 性能工程；3)掌握高级生物统计学和影响评估方法的技能；4) 掌握运筹学和建模方法的知识。

Project Summary: Nurse Management of Hypertension in Rural Western Kenya Cardiovascular disease (CVD) is the leading cause of death in sub-Saharan Africa among adults above age 30. The prevalence of hypertension, a major risk factor for CVD, is increasing over time in sub-Saharan Africa, exerting a significant epidemiologic and economic burden on the region. Without adequate control of hypertension, its health and economic burden will increase drastically in the decades ahead. Well established and evidence-based interventions to manage hypertension exist. However, treatment and control rates are low, due to several reasons including lack of an effective chronic disease management platform, inadequate access to essential medicines, and insufficient human resources. One strategy to improve delivery of hypertension care is task-shifting, in which specific tasks are "shifted" from highly qualified health workers to health workers with shorter training and fewer qualifications. Thus, the overall objective of this project is to utilize a multi- disciplinary implementation research approach to optimize delivery of hypertension care in sub-Saharan Africa, focusing on a task-shifting strategy involving nurse management of hypertension. The candidate, Dr. Rajesh Vedanthan, Assistant Professor of Medicine/Cardiology at Mount Sinai School of Medicine, aims to become an independent clinical investigator specializing in implementation research, in order to optimize the delivery of cardiovascular prevention and treatment interventions in low- and middle-income countries. His career development plan, targeted to this career goal, incorporates a multi-disciplinary program carefully designed to provide an intense, closely mentored, implementation research experience in combination with a structured didactic curriculum. The candidate will conduct the proposed research in rural western Kenya in collaboration with the United States Agency for International Development-Academic Model Providing Access to Healthcare (AMPATH) Partnership. Aim 1 is to evaluate facilitators and barriers to implementation of nurse-based management of hypertensive patients, by conducting a rapid assessment procedure. Aim 2 is to utilize a participatory, iterative, human-centered design process to develop a smartphone-based decision support and integrated record-keeping (DESIRE) tool to be used by nurses for hypertension management. Aim 3 is to conduct an impact evaluation of a pilot program for nurse-based management of hypertension to be implemented by AMPATH. Aim 4 is to estimate the nurse workforce requirements for stable, long-term treatment of hypertension using a needs-based workforce estimation model. The specific aims will be accomplished under the guidance of a multidisciplinary team of mentors and advisors with complementary expertise. The project is guided by the following career objectives: 1) develop expertise in qualitative methods and community-based participatory research; 2) develop competence in management sciences and human performance engineering; 3) acquire skills in advanced biostatistical and impact evaluation methods; and 4) acquire knowledge of the methods of operations research and modeling.