Collaboration Oriented Approach to Controlling High blood pressure (COACH)

项目摘要 背景高血压在成年人中很常见，尽管事实上它是可以控制的，但40%的成年人患有高血压。 高血压患者没有得到控制，心脏病发作、中风和 肾衰竭控制高血压可以通过药物和行为的改变来实现 和生活方式，包括减肥，改变饮食，增加活动，减少酒精摄入，停止 烟草使用。这些都需要自我管理和监测血压;新的工具，如网络 应用程序可以帮助提供这种支持，但需要标准化的方法来反映建议， 控制血压，更好地吸引高血压患者。我们的创新将联合收割机 社会认知理论和行为经济学与基于标准的CDS工具，以改善血液 压力控制 目标.该提案的目标是实现可共享、可互操作和可扩展的面向患者的临床 高血压的决策支持。我们的目标是完善和实施一个面向患者， 适应性协作导向的方法来控制高血压（COACH CDS系统在3 多样化的设置，使用实施科学和患者参与，以最大限度地提高效率。然后我们 将进行一项混合方法研究，包括使用实施科学的随机对照试验， 社会认知理论，以测试应用程序在降低血压方面的有效性;最后， 强大的、可共享的、可互操作的机制，以帮助进一步传播和实施患者- 面对CDS我们的方法将是实施现有的，互操作的CDS到3个不同的网站，然后 进行随机对照试验，包括定性和定量成分，以了解有效性 和执行问题。我们将与包括患者在内的众多团体合作， 传播我们的工作。

PROJECT SUMMARY Background. High blood pressure is common in adults, and – despite the fact it can be controlled – 40% of those with high blood pressure do not have it controlled and remain at high risk for heart attack, strokes, and kidney failure. Controlling high blood pressure can be achieved through medications and changes in behavior and lifestyle, including losing weight, changing diets, increasing activity, reducing alcohol intake, and stopping tobacco use. These require self-management and monitoring of blood pressure; new tools such as web applications can help provide this support, but need standardized approaches to reflect recommendations for blood pressure control and to better engage those with high blood pressure. Our innovation will combine social cognitive theory and behavioral economics with a standards based CDS tool to improve blood pressure control. Goal. The goal of the proposal is to implement sharable, interoperable, and scalable patient-facing clinical decision support for high blood pressure. Our objectives are to refine and implement a patient-facing, adaptable Collaboration Oriented Approach to Controlling High blood pressure (COACH CDS system in 3 diverse settings, using implementation science and patient engagement to maximize effectiveness. Then, we will perform a mixed methods study including a randomized controlled trial using implementation science and social cognitive theory to test effectiveness of the application at lowering blood pressure; and finally to develop robust, sharable, interoperable mechanisms to aid in further dissemination and implementations of patient- facing CDS. Our methods will be to implement existing, interoperable CDS into 3 different sites and then perform a randomized controlled trial with qualitative and quantitative components to understand effectiveness and implementation issues. We will collaborate with a broad number of groups – including patients – to further disseminate our work.