Heart-Related Multiple Chronic Conditions in Primary Care: Behavioral Technology

项目总结/摘要 该R 01提案旨在测试一种计算机技术（C-CHESS），该技术提供了一种通用的方法， 慢性疾病（MCC）。在医疗保险受益人中，65%有3个或更多MCC，23%有5个或更多MCC。 更多. MCC患者占医疗保险支出的90%。MCC通常在初级保健中解决。 初级保健中不断增加的工作量通常会阻止临床医生解决自我管理技能， 尽管目标设定和跟踪等技能对于管理慢性病很重要。 行为干预，如认知行为疗法，自我监控和社会支持可以改善 自我管理技能和健康成果，以及技术可以有效地提供这种干预措施。 C-CHESS（慢性病健康增强支持系统）提供工具，动机， 社会支持，以帮助MCC患者更好地管理他们的病情，包括出现的互动， 在这些条件的组合中。C-CHESS建立在成功行为干预的要素之上： 持续时间、正在进行的外联、监测、提示、行动规划、解决问题、自我调整和同行 支持. C-CHESS通过及时传达患者状态的重要变化来减轻临床医生的负担 以及通过改善病人自我管理减少初级保健就诊。C-CHESS将在一个 在威斯康星州南部的5个初级保健诊所进行的随机临床试验。该试验将涉及330名年龄 65岁及以上，患有以下3种或全部4种疾病：高血压、高脂血症、糖尿病和骨关节炎。 患者将被分配至常规治疗+ C-CHESS或常规治疗+上网。的 试验将持续12个月，随访6个月。该试验的目的是检测两种方法之间的差异。 生活质量和初级保健的使用。其次，该试验旨在检测两种方法之间的差异。 分组：（1）测量每种情况（血压、低密度脂蛋白、血糖和疼痛）;（2）综合评分 结合了个体测量;以及（3）患者具有的症状的数量来自8个列表。审判将 还检查了可能调解干预措施和结果之间关系的因素： 药物和预约出勤，以及自我决定理论的3个组成部分（患者 能力、与他人的关系和动机）。最后，试验将检查可能影响 C-CHESS和结果之间关系的强度：性别，年龄和慢性疾病的数量。 如果成功，C-CHESS将改善健康状况，减轻大量初级保健的负担， 越来越多的、昂贵的病人群体，他们的病情现在还没有得到很好的解决。成功 实施可能意味着从以地点为基础的护理转变，侧重于医疗管理， 定期护理的重点是帮助病人管理自己的条件，通过一个系统建立在证明 有效行为干预的原则，使患者和临床医生都很容易使用。

PROJECT SUMMARY/ABSTRACT This R01 proposal seeks to test a computer technology (C-CHESS) that offers a common approach to multiple chronic conditions (MCCs). Among Medicare beneficiaries, 65% have 3 or more MCCs and 23% have 5 or more. People with MCCs account for 90% of Medicare spending. MCCs are usually addressed in primary care. Increasing workloads in primary care often prevent clinicians from addressing self-management skills with patients, though such skills as goal-setting and tracking are important for managing chronic conditions. Behavioral interventions such as cognitive behavioral therapy, self-monitoring, and social support can improve both self-management skills and health outcomes, and technology can effectively deliver such interventions. C-CHESS (Chronic Condition Health Enhancement Support System) provides tools, motivation, and social support to help patients with MCCs better manage their conditions, including interactions that arise among the combination of conditions. C-CHESS is built on elements of success behavioral interventions: long duration, ongoing outreach, monitoring, prompts, action planning, problem solving, self-tailoring, and peer support. C-CHESS addresses clinician burden by promptly communicating important changes in patient status and—by improving patient-self-management—reducing primary care visits. C-CHESS will be tested in a randomized clinical trial in 5 primary care clinics in southern Wisconsin. The trial will involve 330 patients age 65 and older with 3 or all 4 of these conditions: hypertension, hyperlipidemia, diabetes, and osteoarthritis. Patients will be assigned to treatment as usual + C-CHESS or treatment as usual + access to the Internet. The trial will last 12 months with a 6-month follow up. The goal of the trial is to detect differences between the 2 groups in quality of life and use of primary care. Secondarily, the trial aims to detect differences between the 2 groups in (1) measures for each condition (blood pressure, LDL, blood sugar, and pain); (2) a composite score that combines the individual measures; and (3) number of symptoms patients have from a list of 8. The trial will also examine factors that may mediate the relationship between the interventions and outcomes: adherence to medications and appointment attendance, as well as the 3 components of self-determination theory (patient competence, relatedness to others, and motivation). Finally, the trial will examine factors that may affect the strength of the relationship between C-CHESS and outcomes: gender, age, and number of chronic conditions. If successful, C-CHESS will improve the health and reduce the burden on primary care of a large, growing, expensive group of patients whose conditions are not now well addressed. Successful implementation may point to a shift from care that is place-based, focused on medical management, and periodic to care focused on helping patients manage their own conditions through a system built on the proven principles of effective behavioral interventions made easy for both patients and clinicians to use.