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（由申请人提供）：高血压影响着近7000万美国人，其中得到有效控制的不到一半。由于未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，制定具有成本效益和可扩展的高血压控制策略已被确定为国家的当务之急。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且简单的两步非办公室血压控制策略：(a)患者在家中使用远程监护仪测量血压，远程监护仪存储血压数据，并通过电话调制解调器将数据电子传输给药剂师；(b)在定期电话访问中，药剂师就药物依从性和生活方式向患者提供建议，并根据与初级保健医生的合作实践协议调整降压治疗。这个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，在入组后的6个月和12个月，它使达到并维持血压控制的患者比例翻了一番（常规治疗组31.4%，干预组58.5%，P= 0.0002）。随访12个月，干预组收缩压较常规护理组降低11 mm Hg (P<0.0001)，舒张压较常规护理组降低5 mm Hg （P=0.02）。本提案的目的是扩大对参与HyperLink干预和常规护理组的450名患者的随访，以实现三个具体目标：(a)提供关于长期持久性的新数据；(b)评估HyperLink干预的成本效益；(c)使用混合方法确定成功实施干预并将其转化为实践的关键因素。所有患者将被邀请在入组后36个月、48个月和60个月参加两次临床研究访问，测量血压。扩展的数据将包括BMI的系列评估、降压治疗和依从性、家庭血压监测的使用、对医疗护理的满意度以及临床心血管事件的监测。长期健康影响和成本效益将通过直接观察措施和最先进的心血管事件和治疗费用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交付，以及2)转化为临床实践的策略和障碍。这些结果将填补极其重要的知识空白，并提供有关的实用信息