Designing a Remote Monitoring Intervention for Value & Equity in Hypertension (DRIVE-HTN)

项目摘要 这是一份职业发展奖的申请书，申请人是耶鲁大学的助理教授Elaine Khoong博士。 加州旧金山弗朗西斯科大学，他的职业目标是成为一名嵌入式医疗系统研究员 应用信息学在安全网系统中进行干预性实施研究， 心血管疾病的差异。该奖项将为她提供培训和研究经验，以： (1)为安全网患者和临床医生量身定制家庭血压监测计划;（2）试点 评估实施和初步有效性结果的计划;（3）评估 干预。为了促进这些活动的成功完成，孔博士已经组装了一个理想的 指导团队由主要导师Urmimala Sarkar博士组成，他是实施数字健康的专家 改善安全网系统中慢性病管理的解决方案和三位共同导师：Courtney博士 莱尔斯是一位实施科学家，擅长以人为本的设计和创新实施， 安全网系统; Kirsten Bibbins-Domingo博士，心血管流行病学专家，健康差距， 和干预措施对心血管结局的影响建模;和Dhruv Kazi博士，心脏病专家，健康 经济学家，在低资源环境下的心血管干预措施的成本效益分析专家。 安全网卫生系统不成比例地照顾低收入或少数民族人口， 在实现国家高血压控制和差距目标方面发挥关键作用。因此，开发 并在这些系统中测试可供患者和临床医生使用的实用解决方案。孔博士会 建立在以前工作的结果，这些结果表明：（a）低收入人群采用数字化工具的可用性障碍 或卫生知识普及程度有限的人口，以及（B）实施安全网系统创新的挑战 当不考虑工作流和基础设施时。在目标1中，孔博士将采用以人为本的 设计技术来设计用于安全网系统的家庭血压监测程序。博士 Khoong将领导和评估两个城市安全网诊所的干预试点实施， 孔博士在旧金山弗朗西斯科的安全网系统中担任普通内科医生（目标2）。的 评估将包括实施结果、初步成效结果和成本评估 (Aim 3）为设计更大的实施效果提供基础和初步数据 家庭血压监测计划的试验，可以在R 01提案中进行评估。 通过有针对性的指导培训和课程计划，候选人将获得以下技能：（1） 以人为本的设计;（2）设计，实施和评估干预措施，通过嵌入式 研究模型;（3）成本效益分析。这些技能将有助于孔博士过渡到 独立性，通过独特的定位来解决患者、临床医生和系统级的采用障碍 并实施循证实践，以改善安全网患者的心血管结局。

PROJECT SUMMARY This is an application for a Career Development Award for Dr. Elaine Khoong, an Assistant Professor at the University of California San Francisco, whose career goal is to be an embedded health system researcher that applies informatics to conduct interventional implementation research in safety net systems to reduce disparities in cardiovascular disease. This award will provide her with the training and research experience to: (1) design a home blood pressure monitoring program tailored for safety net patients and clinicians; (2) pilot the program to assess implementation and preliminary effectiveness outcomes; and (3) evaluate the cost of the intervention. To facilitate successful completion of these activities, Dr. Khoong has assembled an ideal mentoring team comprised of primary mentor, Dr. Urmimala Sarkar, an expert in implementing digital health solutions to improve chronic disease management in safety net systems and three co-mentors: Dr. Courtney Lyles, an implementation scientist with expertise in human-centered design and innovation implementation in safety net systems; Dr. Kirsten Bibbins-Domingo, an expert in cardiovascular epidemiology, health disparities, and modeling impact of interventions on cardiovascular outcomes; and Dr. Dhruv Kazi, a cardiologist, health economist, and expert in cost-effectiveness analysis of cardiovascular interventions in low-resourced settings. Safety-net health systems, which disproportionately care for low-income or minority populations, play a pivotal role in achieving national hypertension control and disparities goals. Therefore, it is essential to develop and test pragmatic solutions that can be used by both patients and clinicians in these systems. Dr. Khoong will build on findings from previous work that shows (a) usability barriers to adoption of digital tools in low-income or limited health literate populations and (b) challenges to implementing innovations in safety net systems when workflows and infrastructure are not considered. In Aim 1, Dr. Khoong will employ human-centered design techniques to design a home blood pressure monitoring program for use in safety net systems. Dr. Khoong will lead and evaluate a pilot implementation of the intervention in two urban, safety net clinics within the safety net system in San Francisco where Dr. Khoong practices as a general internist (Aim 2). The evaluation will include implementation outcomes, preliminary effectiveness outcomes, and a cost evaluation (Aim 3), which will provide the foundation and preliminary data to design a larger implementation-effectiveness trial of the home blood pressure monitoring program, which can be assessed in an R01 proposal. Through a focused program of mentored training and coursework, the candidate will gain skills in: (1) human-centered design; (2) design, implementation, and evaluation of interventions through embedded research models; and (3) cost-effectiveness analysis. These skills will facilitate Dr. Khoong’s transition to independence by uniquely positioning her to address patient-, clinician-, and system-level barriers to adoption and implementation of evidence-based practices to improve cardiovascular outcomes in safety net patients.