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Remote Monitoring and Virtual Collaborative Care for Hypertension Control to Prevent Cognitive Decline

远程监控和虚拟协作护理控制高血压以防止认知能力下降

基本信息

批准号：
10045856
负责人：
JEFFREY Murray BURNS
金额：
$ 76.12万
依托单位：
UNIVERSITY OF KANSAS MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-08-01 至 2021-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10045856
关键词：
Adherence Administrator Adopted Adoption Adverse effects Agreement Algorithms Alzheimer&apos s disease related dementia American American Heart Association Antihypertensive Agents Atherosclerosis Blood Pressure Blood Pressure Monitors Cardiology Cardiovascular system Caring Clinic Clinic Visits Clinical Pharmacists Clinical Trials Cognition Collaborations Dementia Dose Education Effectiveness Elderly Electronic Health Record Enrollment Ensure Event Foundations Frequencies Future Goals Guidelines Health system Healthcare High Prevalence Home Blood Pressure Monitoring Home environment Hypertension Impaired cognition Incentives Incidence Institution Institutional Review Boards Intention Intervention Kansas Knowledge Logistics Manuals Measures Modeling Monitor Outcome Patients Pharmacists Pharmacy facility Phase Positioning Attribute Prevalence Prevention Primary Health Care Procedures Process Public Health Randomized Reading Recording of previous events Resources Risk Safety Sample Size Secure Site Structure System Testing Time Transportation Universities Utah age related base blood pressure reduction blood pressure regulation cardiovascular disorder risk cardiovascular risk factor clinical care cohort collaborative care college cost dashboard dementia risk design effectiveness implementation study effectiveness trial health care service utilization human old age (65+)hypertension control implementation science improved mild cognitive impairment mobile application mortality multidisciplinary new technology older patient operation phase 2 testing pragmatic trial prevent primary outcome programs recruit satisfaction secondary outcome shared decision making treatment as usual virtual

项目摘要

Abstract/Project Summary Aggressive management of hypertension (HTN) may reduce the incidence of cognitive impairment, dementia, and Alzheimer’s disease and related dementias (ADRD). Despite this, 3 out of 4 older adults with HTN fail to reach blood pressure (BP) goals. Multiple barriers conspire against the efforts of patients and their clinicians to optimize BP in older patients. We believe these barriers are largely surmountable by reorganization of the current model of HTN management and leveraging new technology, implementation science, and team-based system-wide processes. Given the high prevalence of HTN, these health system-wide efforts may have a large impact on the prevalence of ADRD. As a potential public health approach to ADRD prevention, we propose a pragmatic-implementation study testing a health-system wide strategy leveraging home BP monitoring and a “virtual” Collaborative Care Clinic (vCCC) deployed in two health systems. We hypothesize this approach will safely and effectively lower BP and slow age-related decline in cognition while reducing cardiovascular risk, mortality, and health care utilization. The study will be structured in two phases. The primary objective of Phase I (R61) is to demonstrate feasibility, assess patient acceptability and satisfaction, and refine processes and procedures to enable high scale delivery of the vCCC at the health system level. We will obtain IRB approval, engage key stakeholders (health system, PCP’s and patients), optimize electronic health record (EHR) processes (alerts and referrals), refine care algorithms and processes, and launch the intervention in 3 primary care clinics. We will enroll n= 60 patients to vCCC for 3 months to assess important implementation outcomes and inform go / no-go decisions. Upon achieving the milestones of Phase I, we will scale the program to meet the Phase II (R31) objective of implementing the intervention across two different health systems (Universities of Kansas and Utah Health Systems) to randomize n=1000 patients to vCCC vs. controls (usual care with education) for 2 years. We will assess effectiveness of vCCC in achieving BP goals (1º) and reducing 2º measures of cognitive decline, major adverse cardiovascular events, atherosclerotic cardiovascular disease risk, health care resource utilization, and mortality. We will also assess critical implementation outcomes relevant to wide-scale adoption including feasibility, acceptability, appropriateness, and intention to adopt. Our multidisciplinary collaborative team and history of collaboration with our health system provides an excellent foundation for this study. We have the necessary expertise in clinical trials for ADRD prevention, HTN management, and EHR focused pragmatic trials at both institutions. With the successful implementation of our BP lowering program across the two health systems, we will be well-positioned to scale the model to multiple health systems for definitive testing on reducing the incidence of ADRD in a much larger cohort.

摘要/项目摘要积极管理高血压(HTN)可以减少认知障碍、痴呆症、阿尔茨海默病和相关痴呆(ADRD)的发生率。尽管如此，四分之三的患有HTN的老年人未能达到血压(BP)目标。多重障碍共同阻碍了患者及其临床医生优化老年患者血压的努力。我们相信，通过重组目前的HTN管理模式，并利用新技术、实施科学和基于团队的全系统流程，这些障碍在很大程度上是可以克服的。鉴于HTN的高流行率，这些卫生系统的努力可能会对ADRD的流行率产生很大影响。作为预防ADRD的一种潜在的公共卫生方法，我们提出了一项务实的实施研究，测试利用家庭血压监测和在两个卫生系统中部署的“虚拟”协作护理诊所(VCCC)的卫生系统范围的战略。我们假设这种方法将安全有效地降低血压，减缓与年龄相关的认知衰退，同时降低心血管风险、死亡率和医疗保健利用率。研究将分两个阶段进行。第一阶段(R61)的主要目标是证明可行性，评估患者的可接受性和满意度，并改进流程和程序，以便能够在卫生系统层面上大规模提供VCCC。我们将获得IRB批准，吸引关键利益相关者(医疗系统、初级保健医生和患者)，优化电子健康记录(EHR)流程(警报和转诊)，改进护理算法和流程，并在3家初级保健诊所启动干预。我们将招募n=60名患者参加VCCC，为期3个月，以评估重要的实施结果，并告知是否通过的决定。在实现第一阶段的里程碑后，我们将扩大该计划，以满足第二阶段(R31)目标，即在两个不同的医疗系统(堪萨斯大学和犹他州医疗系统)实施干预措施，将n=1000名患者随机分配到VCCC和对照组(常规护理和教育)，为期2年。我们将评估VCCC在实现BP目标(1？)和减少2：测量认知功能减退、主要心血管不良事件、动脉粥样硬化性心血管疾病风险、医疗资源利用率和死亡率方面的有效性。我们还将评估与大规模采用相关的关键实施成果，包括可行性、可接受性、适当性和采用意向。我们的多学科合作团队和与我们的卫生系统的合作历史为这项研究提供了良好的基础。我们在两个机构的ADRD预防、HTN管理和EHR重点实用试验的临床试验方面拥有必要的专业知识。随着我们的降血压计划在两个医疗系统中的成功实施，我们将处于有利地位，将该模型扩展到多个医疗系统，以在更大的队列中最终测试降低ADRD的发生率。