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

拉美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 在获取和利用护理方面存在结构性障碍。Latinx患者有患高血压(HTN)的风险，并且 不太可能获得必要的护理来管理这种情况。远程等数字健康工具 患者监控(RPM)有可能改善患有HTN的Latinx患者的护理 频繁和量身定做的血压监测，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增强护理决策。然而，有重要的 在获取和使用这些数字工具方面的差距，以及对公平和可持续的挑战 实施。为了缩小这些差距，迫切需要找出方法来装备和促进 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护理更适合不同的患者需求。社区卫生工作者(CHW)是 经过专门培训，解决健康的社会和结构性决定因素，以帮助患者管理健康 条件，提供文化和背景合格的支持，并驾驭复杂的卫生系统； 使能“CHW具有潜在的催化剂，以改善对Latinx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、量化和 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 为启用RPM的CHW提供特定的培训和EHR支持工具，可以改善HTN控制并减少 患有失控HTN的Latinx患者之间的不平等。具体地说，我们寻求：1)发展适应社区 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 以CFIR模式为指导的工具(“CHW RPM-EHR”)，以加强Latinx的高血压管理 患者；2)评估启用RPM的CHWS与标准护理RPM高血压的有效性 300名拉美裔无节制高血压患者的降压管理； 应用Proctor的实施成果框架(IOF)来评估启用RPM的实施情况 用于HTN管理的CHWS，并检查采用率、可接受性、保真度、成本、可持续性和公平性 落实实效的机制。主要成果将是HTN管理的改善 在12个月的时候。我们将使用混合方法-包括基于电子病历的数据审查、患者调查、 与PCP、RNS、CHW和患者进行深度访谈-新的共识建立、以用户为中心的设计和 敏捷开发技术和理论驱动的实现评估框架，以评估 干预。这项研究将有助于为我们不同的患者群体实施RPM提供信息，以及 更深入地了解使用CHW将RPM扩展到Latinx的机会和挑战 并最终改善卫生公平。

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.