Blood Pressure-Visit Intensification for Successful Improvement of Treatment

加强血压就诊以成功改善治疗

• 批准号: 8889719
• 负责人: Kevin Fiscella
• 金额: $ 66.02万
• 依托单位: UNIVERSITY OF ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-01 至 2016-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8889719
• 关键词: Abbreviations; Address; Adherence; Adoption; Affect; Attitude; Awareness; Blood Pressure; Cardiovascular Diseases; Cardiovascular system; Caring; Clinical; Cluster randomized trial; Communication; Community Health Centers; Comorbidity; Computerized Medical Record; Conduct Clinical Trials; Data; Diagnosis; Expert Opinion; Federally Qualified Health Center; Frequencies; Goals; Guidelines; Health; Hypertension; Insurance; Intervention; Joints; Knowledge; Low income; Mediating; Mediator of activation protein; Medical; Methods; Minority; Morbidity - disease rate; New York; Office Visits; Pathway interactions; Patient Schedules; Patients; Perception; Pharmaceutical Preparations; Phase; Physicians; Prevention; Recommendation; Research; Research Project Grants; Resistant Hypertension; Testing; Underrepresented Minority; United States National Institutes of Health; Universities; Visit; abstracting; acronyms; base; blood pressure regulation; cardiovascular risk factor; design; evidence base; follow-up; hypertension treatment; improved; mortality; practice-based research network; pragmatic trial; racial disparity; randomized trial; skills; success; treatment as usual

DESCRIPTION (provided by applicant): Abstract Blood pressure (BP) control among hypertensive patients reduces cardiovascular morbidity and mortality. Yet, BP is controlled at only 56% of hypertension-related office visits. Worse control of BP among Blacks is a key contributor to racial disparities in cardiovascular disease. The Seventh Joint National Committee on the Diagnosis, Prevention and Treatment of Hypertension (JNC VII) address hypertension management. While clinician adoption of JNC VII guidelines has steadily improved relevant to initiation of BP treatment and medication selection, clinicians have largely failed to implement the JNC recommendation for monthly visits for patients with uncontrolled BP. This translational gap represents a potential opportunity to improve suboptimal BP control while also addressing disparities in BP control. The primary aim of this research project is to improve clinician implementation of the JNC guideline for monthly visits for hypertensive patients with uncontrolled BP. Our secondary aim is improved BP control. We propose to accomplish these aims using a theoretically informed and evidence-based multimodal quality improvement intervention implemented within the Clinical Directors Network, a practice based research network of federally qualified health centers (FQHCs). Our central hypothesis is that targeting clinician awareness, attitudes, skills and routines relevant to this recommendation will improve patient visit frequency. Our secondary hypothesis is that improving visit frequency will improve BP control. We propose to rigorously test these important hypotheses through a pragmatic randomized trial that uses a stepped wedge phase-in of the intervention in participating FQHCs. We will assess visit frequency and BP through abstraction of data from electronic medical records of participating practices. Our specific aims are: Aim 1: To implement the JNC recommendation for monthly visits for hypertensive patients with uncontrolled BP using a theoretically-informed, empirically grounded, multimodal QI intervention. Aim 2: To improve BP control and reduce disparity in BP through implementation of monthly visits. Aim 3: To assess potential mediators and moderators of the intervention. Findings have national implications for best strategies for effective implementation of this guideline. If successful, implementation of monthly visits represents a simple and feasible means for improving BP control, and potentially, for addressing racial disparities in BP control. To our knowledge, this project will be the first randomized trial of implementation of monthly visits to improve BP. Our team, which includes experts in hypertension, pragmatic trials, FQHC research, and clinician-patient communication, is well suited to undertake this study and disseminate findings through formal and informal networks.

描述（由申请人提供）：高血压患者中的抽象血压（BP）控制降低了心血管发病率和死亡率。然而，BP仅在与高血压相关的办公室访问中只有56％的控制。黑人对BP的控制较差是导致心血管疾病种族差异的关键因素。第七届全国诊断，预防和治疗高血压（JNC VII）的联合委员会涉及高血压管理。虽然临床医生对JNC VII指南的采用已稳步改善与BP治疗和药物选择的启动相关，但临床医生在很大程度上未能实施JNC建议，以针对未受控制的BP患者每月访问。这种翻译差距代表了改善次优的BP控制的潜在机会，同时还解决了BP控制中的差异。该研究项目的主要目的是改善临床医生实施JNC指南，以针对非控制力BP的高血压患者每月访问。我们的次要目标是改善BP的控制。我们建议使用理论知情的和基于证据的多模式改进干预措施来实现这些目标，该临床董事网络中实施了基于实践的联邦合格卫生中心（FQHC）的研究网络。我们的核心假设是，针对临床医生的意识，态度，技能和常规，与此建议有关，将提高患者的访问频率。我们的次要假设是，提高访问频率将改善BP的控制。我们建议通过一项务实的随机试验对这些重要的假设进行严格检验，该试验使用干预措施参与FQHC的阶梯阶段。我们将通过从参与实践的电子医疗记录中抽象数据来评估访问频率和BP。 我们的具体目的是：目标1：使用理论上有信息的，经验的，多模式的QI干预措施实施JNC建议，以针对非控制BP的高血压患者进行每月访问。 目标2：通过实施每月访问来改善BP控制并减少BP的差异。 目标3：评估干预的潜在介体和主持人。调查结果对有效执行本指南的最佳战略具有国家的影响。如果成功的话，每月访问的实施代表了改善BP控制的一种简单且可行的手段，并有可能解决BP控制中的种族差异。据我们所知，该项目将是每月访问以改善BP的第一个随机试验。我们的团队包括高血压，务实试验，FQHC研究和临床医生沟通的专家，非常适合通过正式和非正式网络进行这项研究并传播发现。