Nurse Management of Hypertension in Rural Western Kenya

项目摘要：肯尼亚西部农村地区高血压的护士管理 心血管疾病（CVD）是撒哈拉以南非洲地区老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，在撒哈拉以南非洲地区，其患病率随着时间的推移而不断增加。 对该地区造成重大的流行病学和经济负担。如果没有充分的控制 高血压，其健康和经济负担将在未来几十年急剧增加。完善 存在治疗高血压的循证干预措施。然而，治疗率和控制率较低， 由于缺乏有效的慢病管理平台、准入不足等多种原因 基本药物缺乏，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，具体任务从高素质卫生工作者“转移”给卫生工作者 培训时间较短，资格证书较少。因此，该项目的总体目标是利用多 优化撒哈拉以南非洲高血压护理服务的学科实施研究方法， 重点关注涉及高血压护士管理的任务转移策略。候选人拉杰什博士 Vedanthan 是西奈山医学院医学/心脏病学助理教授，目标是成为一名 专门从事实施研究的独立临床研究者，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措施。他的职业生涯 针对这一职业目标的发展计划包含精心设计的多学科计划 提供深入、密切指导的实施研究经验，并结合结构化的 教学课程。候选人将合作在肯尼亚西部农村地区进行拟议的研究 与美国国际开发署合作 - 提供医疗保健的学术模式 （AMPATH）合作伙伴关系。目标 1 是评估实施基于护士的计划的促进因素和障碍 通过进行快速评估程序来管理高血压患者。目标 2 是利用 参与式、迭代式、以人为本的设计流程，开发基于智能手机的决策支持和 护士用于高血压管理的综合记录保存（DESIRE）工具。目标 3 是 对以护士为基础的高血压管理试点计划进行影响评估 由 AMPATH 实施。目标 4 是估计稳定、长期的护士队伍需求 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 在由导师和顾问组成的多学科团队的指导下完成 专业知识。该项目以以下职业目标为指导：1）发展定性方法方面的专业知识 和基于社区的参与性研究； 2) 培养管理科学和人文方面的能力 性能工程； 3）获得先进的生物统计和影响评估方法的技能；和 4) 获取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.