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

控制合作伙伴：与社区卫生工作者一起使用远程监测技术来支持拉丁裔患者的高血压管理

• 批准号: 10669469
• 负责人: Devin M Mann
• 金额: $ 70.02万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-21 至 2028-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10669469
• 关键词: Address; Adoption; Adult; Blood Pressure; Blood Pressure Monitors; Cardiovascular Diseases; Caring; Child Care; Communities; Community Health Aides; Competence; Complex; Consensus; Data; Data Analytics; Decision Making; Devices; Disparity; Effectiveness; Electronic Health Record; Environment; Equity; Exposure to; Face; Goals; Health; Health Disparities Research; Health Services Accessibility; Health Technology; Health system; Healthcare; Hypertension; Improve Access; Individual; Inequity; Informatics; Infrastructure; Intervention; Interview; Language; Latinx; Methods; Modeling; Neighborhood Health Center; Office Visits; Outcome; Patient Care; Patients; Population; Population Heterogeneity; Proctor framework; Provider; Research; Research Design; Resources; Risk; Services; Surveys; System; Technology; Training; Training Activity; Transportation; United States; Work; access disparities; blood pressure reduction; catalyst; clinical practice; cost; design; digital; digital health; digital tool; disparity reduction; effectiveness evaluation; empowerment; experience; health care disparity; health care settings; health determinants; health disparity; health equity; health literacy; health management; hypertension control; implementation evaluation; implementation facilitation; implementation outcomes; implementation/effectiveness; improved; insight; member; new technology; novel; patient navigator; patient population; primary care team; primary outcome; remote monitoring; remote patient monitoring; social; social determinants; standard of care; structural health determinants; support tools; technique development; technology validation; theories; tool; user centered design

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.

在美国，拉丁裔成年人经历了心血管疾病的不成比例 通过访问和使用护理的结构障碍。拉丁裔患者有高血压（HTN）的风险，并且是 不太可能能够获得必要的护理来管理这种情况。远程数字健康工具 患者监测（RPM）有可能通过更多 经常和量身定制的血压监测，提供其他健康信息，赋予患者能力， 并增强护理决策，而不会破坏患者的日常生活。但是，有重要的 这些数字工具的访问和使用方面的差异，以及公平和可持续的挑战 执行。为了减轻这些分布，迫切需要确定装备和促进的方法 针对潜水员人群的RPM实施并解决健康的社会，结构和数字决定者 使RPM护理更适合潜水者的患者需求。社区卫生工作者（CHW）是 经过专门针对健康和结构性决定者的培训，以帮助患者管理健康 条件，在文化和上下文上有能力的支持，并在复杂的卫生系统中浏览； “技术 - 启用” CHW有可能是改进拉丁裔患者RPM使用的催化剂。我们的团队完成了 RPM实施和基础设施，CHW培训，信息信息，数字健康，定量和定量的领导者 定性研究设计，数据分析和健康差异研究 - 试图确定是否增加 提供了具有特定培训和EHR支持工具的基于RPM的CHW可以改善HTN控制并减少 Latinx患者不受控制的HTN患者的不平等。特别是，我们寻求：1）开发的改编社区 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 由CFIR模型指导的工具（“ CHW RPM-EHR”）以增强拉丁裔高血压的管理 患者; 2）评估启用RPM的CHW的有效性与护理标准RPM高血压相比 300名拉丁裔高血压患者的血压降低治疗； 3） 应用Proctor的实施成果框架（IOF）来评估启用RPM的实施 用于HTN管理的CHW，并检查采用，可接受性，忠诚，成本，可持续性和公平性 实施有效性的机制。主要结果将是HTN管理的改进 12个月。我们将使用一种混合方法 - 包括基于EHR的数据审查，患者调查，In- 对PCP，RN，CHW和患者的深度访谈 - 新颖的共识建设，以用户为中心的设计和 敏捷发展技术和理论驱动的实施评估框架以评估 干涉。这项研究将有助于为我们的潜水者患者以及 对使用CHW扩大对RPM的访问到Latinx的机遇和挑战提供更大的见解 患者并最终改善健康公平。