Partners IN CONTROL: Using Remote MonitorINg teChnology with cOmmuNity healTh woRkers to support hypertensiOn management for Latinx patients

拉丁裔成年人在美国经历了不成比例的心血管疾病负担，部分原因是 在获得和利用医疗服务方面存在结构性障碍。Latinx患者有高血压（HTN）的风险， 不太可能获得必要的护理来管理这种情况。数字健康工具，如远程 患者监测（RPM）有可能通过实现更多的 频繁和有针对性地监测血压，提供额外的健康信息，增强患者的能力， 并在不干扰患者日常生活的情况下加强护理决策。然而，有重要的 在获得和使用这些数字化工具方面的差距，以及在公平和可持续发展方面的挑战， 实施.为了缩小这些差距，迫切需要确定方法， 为不同人群实施RPM，并解决健康的社会、结构和数字决定因素 使RPM护理更适合不同患者的需求。社区卫生工作者（CHW） 经过专门培训，以解决健康的社会和结构性决定因素，帮助患者管理健康 条件，提供文化和背景能力的支持，并导航复杂的卫生系统;“技术- ”CHW有可能成为催化剂，改善拉丁美洲患者的RPM使用。我们的团队-由 RPM实施和基础设施、CHW培训、信息学、数字健康、定量和 定性研究设计，数据分析和健康差异研究-旨在确定是否增加 支持RPM的CHW提供了特定的培训和EHR支持工具，可以改善HTN控制并减少 不公平的Latinx患者与不受控制的HTN。具体而言，我们寻求：1）发展适应性社区 卫生工作者远程患者监测培训模块（“CHW RPM”）和电子健康记录支持 工具（“CHW RPM-EHR”）由CFIR模型指导，以加强拉丁美洲高血压的管理 患者; 2）评价RPM启用CHW与标准RPM高血压护理相比的有效性 在300例高血压未控制的Latinx患者中进行降压管理;以及3） 应用普罗克特的实施成果框架（IOF）来评估启用RPM的 CHW的HTN管理，并检查采用，可接受性，保真度，成本，可持续性和公平性， 执行有效性机制。主要结果将是HTN管理的改善 12个月大的时候我们将采用混合方法-包括基于EHR的数据审查，患者调查， 与PCP、RNS、CHW和患者的深度访谈--新颖的共识建立、以用户为中心的设计和 敏捷开发技术和理论驱动的实施评估框架，以评估 干预这项研究将有助于为我们多样化的患者人群提供RPM实施信息， 提供更深入的见解，了解使用CHW将RPM的访问扩展到Latinx的机会和挑战 患者，并最终改善健康公平。

Latinx adults experience a disproportionate burden of cardiovascular disease in the United States, driven in part by structural barriers to accessing and utilizing care. Latinx patients are at risk for hypertension (HTN), and are less likely to be able to access necessary care to manage this condition. Digital health tools such as remote patient monitoring (RPM) have potential to improve the care of Latinx patients with HTN by enabling more frequent and tailored monitoring of blood pressure, providing additional health information, empowering patients, and enhancing care decision-making without disrupting patients’ daily lives. However, there are significant disparities in the access and use of these digital tools, as well as challenges to equitable and sustainable implementation. To mitigate these disparities, there is urgent need to identify methods to equip and facilitate the implementation of RPM for diverse populations and address social, structural, and digital determinants of health to make RPM care more appropriate for diverse patient needs. Community health workers (CHWs) are specifically trained to address social and structural determinants of health to help patients manage health conditions, provide culturally and contextually competent support, and navigate complex health systems; “tech- enabled” CHWs have potential to be catalysts for improved RPM use for Latinx patients. Our team – comprised of leaders of RPM implementation and infrastructure, CHW training, informatics, digital health, quantitative and qualitative study design, data analytics, and health disparities research – seeks to determine if the addition of RPM-enabled CHWs provided with specific training and EHR support tools can improve HTN control and reduce inequities among Latinx patients with uncontrolled HTN. Specifically, we seek to: 1) develop adapted community health worker remote patient monitoring training modules (“CHW RPM”) and electronic health record support tools (“CHW RPM-EHR") guided by the CFIR model to enhance the management of hypertension in Latinx patients; 2) evaluate the effectiveness of RPM-enabled CHWs compared to standard of care RPM hypertension management on blood pressure reduction among 300 Latinx patients with uncontrolled hypertension; and 3) apply Proctor’s Implementation Outcomes Framework (IOF) to evaluate the implementation of the RPM-enabled CHWs for HTN management, and examine adoption, acceptability, fidelity, cost, sustainability, and equity as mechanisms of implementation effectiveness. The primary outcome will be improvements in HTN management at 12 months. We will utilize a mixed methods approach – including EHR-based data review, patient surveys, in- depth interviews with PCPs, RNS, CHWs, and patients – novel consensus-building, user-centered design and agile development techniques, and theory-driven implementation assessment frameworks to assess the intervention. This research will help inform RPM implementation for our diverse patient population, as well as offer larger insights into to the opportunities and challenges of using CHWs to expand access to RPM to Latinx patients and ultimately improve health equity.