Implementation Strategies for Self-Measured Blood Pressure Monitoring in Racially and Ethnically Diverse Populations (InS2PiRED).

种族和民族多元化人群自测血压监测的实施策略 (InS2PiRED)。

• 批准号: 10831792
• 负责人: Elaine Khoong
• 金额: $ 49.09万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-30 至 2028-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10831792
• 关键词: Implementation; Strategies; Self; Measured; Blood

PROJECT SUMMARY / ABSTRACT This AHRQ R18 proposal focuses on evaluating patient-level and clinic-level strategies to increase implementation of self-measured blood pressure (SMBP) monitoring programs with clinical support; specifically, we focus on identifying approaches to increase SMBP monitoring in safety net settings where many low-income and/or culturally diverse populations who experience worse hypertension control and outcomes receive clinical care. SMBP monitoring is an evidence-based, guideline-recommended practice that is most effective when combined with clinical support. However, SMBP monitoring with clinical support has had limited adoption in many safety net clinical settings due to multi-level barriers. To accelerate adoption of SMBP monitoring with clinical support in safety net settings, we propose to conduct this project in an integrated, urban safety net healthcare system that provides ambulatory care for >50,000 patients. In Aim 1, we will co-design patient-level and clinic-level implementation strategies to increase SMBP monitoring supported by clinical teams. We will conduct three rounds of design sessions in focus groups with English, Spanish, and Chinese-speaking patients with hypertension and clinical care team members (e.g., clinicians, pharmacists, nurses). We will design: (1) two patient-level strategies (a low-intensity strategy of providing cellular-enabled BP monitors and training on its use vs. a high-intensity strategy that adds reminders, training on transmitting BP data to the clinical team, and approaches to engage caregivers/peer in SMBP monitoring activities); and (2) one clinic-level strategy (training of clinical champions and design of electronic health record [EHR] implementation tools). In Aim 2, we will conduct a hybrid type 2 effectiveness- implementation trial and evaluate effectiveness and implementation outcomes. A total of 330 patients will be enrolled for 12 months and randomized to high-intensity vs the low-intensity patient-facing implementation strategy; six primary care clinics will receive the clinic-level implementation strategy in a stepped wedge design. For the patient-level strategy, the primary effectiveness outcome will be change in systolic BP at 12 months and primary implementation outcome will be the number of home BP values measures over the 12- month period. For our clinic-level implementation strategy, the primary effectiveness outcome will be change in clinic-wide BP control and primary implementation outcome will be the frequency of documenting patient- collected BP values. Our secondary outcomes include other clinical outcomes, patient-reported outcomes, and other implementation outcomes, collected from surveys, observations, interviews, and EHR data. In Aim 3, we will conduct a cost-analysis of our implementation strategies and intervention with a focus on understanding the costs of implementing an SMBP monitoring program when supported by our implementation strategies. Data will be collected through surveys, interviews, observations, and review of EHR data.

项目摘要/摘要 本AHRQ R18提案的重点是评估患者和临床层面的策略，以增加 在临床支持下实施自我测量血压（SMBP）监测计划; 具体而言，我们的重点是确定在安全网环境中增加SMBP监测的方法， 许多低收入和/或文化多样性人群的高血压控制较差， 结果得到临床护理。SMBP监测是一种基于证据的指南推荐实践， 与临床支持相结合是最有效的。然而，具有临床支持的SMBP监测已经 由于多级障碍，在许多安全网临床环境中的采用有限。加快采用SMBP 在安全网环境中进行临床支持监测，我们建议在一个综合的城市 为超过50，000名患者提供门诊护理的安全网医疗保健系统。 在目标1中，我们将共同设计患者层面和临床层面的实施策略，以提高SMBP 由临床团队提供支持。我们将举办三轮设计专题讨论会， 讲英语、西班牙语和汉语的高血压患者和临床护理团队成员（例如， 临床医生、药剂师、护士）。我们将设计：（1）两种患者水平的策略（低强度策略， 提供支持手机功能的血压监测器和使用培训，而不是添加提醒的高强度策略， 关于向临床团队传输BP数据的培训，以及在SMBP中吸引护理人员/同行的方法 监测活动）;和（2）一个诊所级战略（培训临床冠军和设计电子 健康记录[EHR]实施工具）。在目标2中，我们将进行混合2型有效性- 执行试验并评价有效性和执行结果。总共将有330名患者 入组12个月，并随机分配至高强度与低强度的面向患者实施 战略;六个初级保健诊所将接受诊所级实施战略， 设计对于患者水平策略，主要有效性结局将是12时收缩压的变化 个月，主要实施结果将是家庭BP值的数量超过12- 月期间。对于我们的诊所级实施策略，主要有效性结果将是 诊所范围内的血压控制和主要实施结果将是记录患者的频率， 收集的BP值。我们的次要结局包括其他临床结局、患者报告结局和 从调查、观察、访谈和EHR数据中收集的其他实施成果。在目标3中，我们 将对我们的实施战略和干预措施进行成本分析，重点是了解 在我们的实施战略支持下实施SMBP监测计划的成本。 将通过调查、访谈、观察和审查EHR数据来收集数据。