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: 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
• 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

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（申请人提供）：高血压影响近7000万美国人，有效控制的不到一半。由于不受控制的高血压是中风、充血性心力衰竭、肾脏疾病和心肌梗死的主要原因，因此开发具有成本效益和可扩展的高血压控制策略已被确定为紧急的国家优先事项。NHLBI资助的随机HyperLink试验（家庭血压远程监测和病例管理以控制高血压）开发并实施了一种非常有效但简单的两步非办公室血压（BP）控制策略：（a）患者在家中使用远程监测器测量BP，所述远程监测器存储BP数据并通过电话调制解调器将其电子传输给药剂师。（B）在定期电话访问中，药剂师建议患者坚持服药和生活方式，并根据与初级保健医生的合作实践协议调整抗高血压治疗。这种简单的策略现在已经在一项随机试验中得到了严格的评估，在该试验中，在入组后6个月和12个月达到并维持血压控制的患者比例增加了一倍（常规治疗组为31.4%，干预组为58.5%，P= 0.0002）。在12个月随访时，与常规护理组相比，干预组的收缩压降低11 mm Hg（P<0.0001），舒张压降低5 mm Hg（P=0.02）。本提案的目的是延长对入选超链接干预和常规护理组的450例患者的随访，以实现三个具体目标：（a）提供关于长期持久性的新数据（B）评估超链接干预的成本效益，以及（c）使用混合方法来确定成功实施干预并将其转化为实践的关键因素。所有患者将被邀请参加两次研究诊所访视，以测量入组后36、48和60个月时的BP。扩展数据将包括BMI、抗高血压治疗和依从性、家庭血压监测的使用、医疗服务满意度和临床心血管事件监测的系列评估。长期健康影响和成本效益将使用直接观察的措施和最先进的心血管事件和治疗成本的微观模拟预测模型进行量化。焦点小组和与研究对象、药剂师和卫生系统利益相关者的半结构化访谈将提供以下方面的额外观点：1）优化干预措施的成功实施; 2）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空白，并提供实用信息， 实施这种可扩展和有效的新护理模式的成本和收益，为改善数百万患有不受控制的高血压的美国人的结果带来了巨大的希望。