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

基本信息

批准号：
7684180
负责人：
KAREN L MARGOLIS
金额：
$ 69.48万
依托单位：
HEALTHPARTNERS INSTITUTE
依托单位国家：
美国
项目类别：
财政年份：
2008
资助国家：
美国
起止时间：
2008-09-15 至 2012-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7684180
关键词：
Address Adult Agreement American Antihypertensive Agents Arts Blinded Blood Pressure Cardiovascular system Caring Case Management Case Manager Chronic Classification Client satisfaction Clinic Clinical Communication Computerized Medical Record Control Groups Data Diabetes Mellitus Education Enrollment Ensure Equipment Event Formularies Future Goals Guidelines Home environment Hypertension Information Systems Intervention Kidney Diseases Length Maintenance Measurement Measures Medical Methods Modeling Modems Office Visits Outcome Patients Performance Pharmaceutical Preparations Pharmacists Phase Physicians Population Heterogeneity Primary Care Physician Primary Health Care Problem Solving Process Protocols documentation Randomized Randomized Controlled Clinical Trials Randomized Controlled Trials Reading Research Research Design Secure Self Management Telephone Testing Therapeutic Therapeutic Intervention Time Touch sensation Visit Writing base blood pressure regulation care systems chronic care model cost effective intervention empowered follow-up hypertension control hypertension treatment improved innovation new technology patient population population based prevent primary care setting public health relevance satisfaction social technological innovation treatment as usual web site

项目摘要

DESCRIPTION (provided by applicant): Blood pressure (BP) is controlled to recommended levels in only 1 in 3 people with hypertension, and there has been little improvement since the late 1980s, despite advances in evidence to support aggressive hypertension control, and availability of many new and effective antihypertensive drugs. It is clear that meaningful and sustained improvement in hypertension control will likely require fundamental changes in the current physician-centered office-visit based model of caring for hypertension. In this project we develop and implement an intervention that takes advantage of new technology and team models of care to improve BP measurement and control, solving the problems that have limited the application of case management approaches to hypertension care improvement. The study will take place in a diverse population of adults with hypertension cared for in a real-world primary care setting. The Telemonitoring Intervention (TI) integrates 2 innovative components: First, home BP measures are done using state-of-the-art modem-enabled automated equipment that internally stores and electronically transmits BP data through a simple touch-tone telephone connection to a secure web site. Second, a pharmacist case manager integrated with the primary care team through a jointly used electronic medical record (EMR) and formulary adjusts antihypertensive therapy using an approved written protocol, under a collaborative practice agreement with physicians. Treatment decisions are based on home BP data and are discussed and communicated to patients in telephone visits with the pharmacist case manager. Two-way communication between the pharmacist case manager and the patient's primary care team is assured by using a shared EMR and by additional secure messaging of the results of every pharmacist encounter to the primary care team. To assess the impact of the TI on hypertension control, patient satisfaction, and costs of care, we will conduct a cluster-randomized trial, assigning 16 primary care clinics and 450 of their nested patients with uncontrolled hypertension to either a Usual Care (UC) control group or TI. Blood pressure outcomes in both groups will be determined at baseline, 6, 12 and 18 months in an identical and blinded fashion in a research clinic separate from the clinical setting where patients received their medical care. We hypothesize that guideline BP control will be achieved at 6 months and maintained at 12 months in more than 60% of patients from TI clinics, compared to < 40% in patients from UC clinics. We will compare satisfaction with care and costs in the TI and UC groups. The TI has the potential to improve hypertension control for millions of patients, and could be implemented widely in diverse and large patient populations based on performance in this randomized trial. The results of the project will have important implications for future efforts to improve care provided to many of the estimated 20 million Americans with uncontrolled hypertension. PUBLIC HEALTH RELEVANCE: In this project we develop and implement an intervention to improve hypertension control in a primary care setting that takes advantage of new technology (home blood pressure telemonitoring) and team models of care (pharmacist case management). The results of the project will have important implications for future efforts to improve care provided to many of the estimated 20 million Americans with uncontrolled hypertension.

描述（由申请人提供）：血压（BP）仅在3分之一的高血压患者中控制为建议的水平，自1980年代后期以来，尽管有证据支持积极的高血压控制，并且提供了许多新的有效的降压药物，但自1980年代后期以来几乎没有改善。显然，高血压控制的有意义且持续的改善可能需要在当前以医师为中心的办公室访问模型的关怀高血压模型中进行基本变化。在这个项目中，我们开发和实施一种干预措施，利用新技术和团队护理模型来改善BP的测量和控制，解决了限制了案例管理方法改善案例管理方法的问题。这项研究将在现实世界中医疗机构中受到高血压的成年人群体中进行。远程监控干预（TI）集成了2个创新组件：首先，使用具有最新的调制解调器的自动化设备进行了家庭BP措施，该设备可以内部存储并通过简单的接触式电话连接到安全网站来传输BP数据。其次，一名药剂师案例经理通过与医生的协作实践协议，使用批准的书面方案通过共同使用的电子病历（EMR）与初级保健团队整合，并配方进行了抗高血压疗法。治疗决策基于家庭BP数据，并与药剂师案件经理进行了讨论并与患者进行了讨论。通过使用共享的EMR以及对每位药剂师遭遇的结果的其他安全消息传递给初级保健团队，可以确保药剂师病例经理与患者的初级保健团队之间的双向沟通。为了评估TI对高血压控制，患者满意度和护理成本的影响，我们将进行集群随机试验，分配16个初级保健诊所和450名未控制高血压的嵌套患者，以使通常的护理（UC）对照组或Ti。两组的血压结果将在基线，6、12和18个月以相同且盲目的方式确定，该研究诊所与患者接受医疗服务的临床环境分开。我们假设指南将在6个月时实现BP控制，并在TI诊所的60％以上的患者中保持在12个月的时间，而UC诊所的患者<40％。我们将比较TI和UC组中的护理和成本的满意度。 TI有可能改善数百万患者的高血压控制，并且可以根据这项随机试验的表现在多样化和大型患者人群中实施。该项目的结果将对未来的努力具有重要意义，以改善许多估计有不受控制的高血压的美国人中的许多美国人的护理。公共卫生相关性：在这个项目中，我们开发并实施了一项干预措施，以在利用新技术（家庭血压远程监控）和团队护理模型（药剂师病例管理）的初级保健环境中改善高血压控制。该项目的结果将对未来的努力具有重要意义，以改善许多估计有不受控制的高血压的美国人中的许多美国人的护理。