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

基本信息

批准号：
8708944
负责人：
KAREN L MARGOLIS
金额：
$ 43.7万
依托单位：
HEALTHPARTNERS INSTITUTE
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-08-01 至 2016-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8708944
关键词：
Address Adopted Affect Agreement American Antihypertensive Agents Blood Pressure Businesses Cardiovascular Diseases Cardiovascular Models Cardiovascular system Caring Case Management Chronic Clinic Visits Clinical Computerized Medical Record Congestive Heart Failure Cost Effectiveness Analysis Costs and Benefits Data Data Collection Development Diastolic blood pressure Effectiveness Effectiveness of Interventions Enrollment Event Focus Groups Frequencies Funding Health Health Priorities Health system Heart Diseases Home Blood Pressure Monitoring Home environment Hypertension Hypotension Incidence Intervention Interview Kidney Diseases Knowledge Life Style Measures Medical Methods Modeling Modems Myocardial Infarction National Heart, Lung, and Blood Institute Nurses Outcome Patients Persons Pharmacists Physicians Primary Care Physician Quality-Adjusted Life Years Randomized Relapse Reporting Research Simulate Stroke Structure Study Subject System Telemedicine Telephone Time Translating Translations Treatment Cost United States Visit Work base blood pressure regulation cost cost effective cost effectiveness experience follow-up group intervention health care model hypertension control improved innovation medication compliance meetings models and simulation public health relevance randomized trial routine practice satisfaction success treatment adherence treatment as usual

项目摘要

DESCRIPTION (provided by applicant): Hypertension affects nearly 70 million Americans, and is effectively controlled in less than half. Because uncontrolled hypertension is a leading cause of stroke, congestive heart failure, renal disease, and myocardial infarction, development of cost-effective and scalable hypertension control strategies has been identified as an urgent national priority. The NHLBI-funded randomized HyperLink trial (Home Blood Pressure Telemonitoring and Case Management to Control Hypertension) has developed and implemented a very effective yet simple two-step non-office-based blood pressure (BP) control strategy: (a) patients measured BP at home using telemonitors that stored and electronically transmitted BP data to a pharmacist via a telephone modem, (b) In periodic telephone visits, pharmacists advised patients on medication adherence and lifestyle, and adjusted antihypertensive therapy under a collaborative practice agreement with primary care physicians. This simple strategy has now been rigorously evaluated in a randomized trial in which it doubled the proportion of patients who achieved and maintained BP control at both 6 and 12 months following enrollment (31.4% in usual care and 58.5% in the intervention group, P=.0002). It achieved systolic BP 11 mm Hg lower (P<0.0001) and diastolic BP 5 mm Hg lower (P=0.02) in the intervention group compared to the usual care group at 12-month follow-up. The purpose of this proposal is to extend follow-up of the 450 patients enrolled in the HyperLink intervention and usual care groups to achieve three specific aims: (a) provide new data on the long-term durability (b) assess the cost-effectiveness of the Hyperlink intervention, and (c) use mixed methods to identify critical factors for delivering the intervention successfully and translating i into practice. All patients will be invited to attend two research clinic visits to measure BP at tme points 36, 48, and 60 months following enrollment. Extended data will include serial assessments of BMI, antihypertensive treatment and adherence, use of home BP monitoring, satisfaction with medical care, and surveillance for clinical cardiovascular events. Long-term health impact and cost-effectiveness will be quantified using directly observed measures and state-of-the-art microsimulation prediction modeling of cardiovascular events and treatment costs. Focus groups and semi- structured interviews with study subjects, pharmacists, and health system stakeholders will provide additional perspectives on 1) optimizing successful delivery of the intervention, and 2) on strategies and barriers for translation into clinical practce. These results will fill critically important knowledge gaps and provide practical information about the costs and benefits of implementing a this scalable and effective new care model that holds great promise for improving outcomes for millions of Americans with uncontrolled hypertension.

描述（由申请人提供）：高血压会影响近7000万美国人，并在不到一半的情况下有效控制。由于不受控制的高血压是中风，充血性心力衰竭，肾脏疾病和心肌梗塞的主要原因，因此已经确定了成本效益和可扩展性高血压控制策略的发展是紧急的国家优先事项。 The NHLBI-funded randomized HyperLink trial (Home Blood Pressure Telemonitoring and Case Management to Control Hypertension) has developed and implemented a very effective yet simple two-step non-office-based blood pressure (BP) control strategy: (a) patients measured BP at home using telemonitors that stored and electronically transmitted BP data to a pharmacist via a telephone modem, (b) In periodic telephone visits, pharmacists advised patients on medication遵守和生活方式，并根据与初级保健医生的协作实践协议调整了降压治疗。现在，在一项随机试验中对这种简单的策略进行了严格的评估，该试验将在入学后6和12个月以6和12个月的6个月和12个月的bp对照患者的比例增加了一倍（在常规护理中为31.4％，干预组为58.5％，p = .0002）。与在12个月的随访中相比，它在干预组中达到了收缩BP 11 mm Hg（p <0.0001）和舒张压bp 5 mm Hg（p = 0.02）。该提案的目的是扩大接受超链接干预措施和常规护理组的450名患者的随访，以实现三个具体目标：（a）提供有关长期耐用性的新数据（b）评估超链接干预的成本效益，以及（c）使用混合方法来识别成功和翻译I练习的关键方法。在入学后，将邀请所有患者参加两次研究诊所就诊，以测量TME点36、48和60个月的BP。扩展数据将包括对BMI的串行评估，降压治疗和依从性，使用家庭BP监测，对医疗服务的满意度以及对临床心血管事件的监视。长期的健康影响和成本效益将通过直接观察到的心血管事件和治疗成本的直接观察到的措施和最新的微观仿真预测进行量化。焦点小组和对研究对象，药剂师和卫生系统利益相关者的半结构化访谈将提供有关1）成功提供干预措施的其他观点，以及2）关于将转化为临床实践的策略和障碍。这些结果将填补至关重要的知识差距，并提供有关的实用信息实施这种可扩展有效的新护理模式的成本和收益，该模型具有巨大的希望，可以改善不受控制的高血压的数百万美国人的预后。