Implementation Science to Improve Cardiovascular Health: Leveraging EHR Systems to Advance Care of Resistant Hypertension

改善心血管健康的实施科学：利用 EHR 系统推进难治性高血压的护理

• 批准号: 10630490
• 负责人: Joseph Ebinger
• 金额: $ 4.84万
• 依托单位: CEDARS-SINAI MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-15 至 2023-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10630490
• 关键词: Acute Renal Failure with Renal Papillary Necrosis; Address; Affect; Algorithms; American; Antihypertensive Agents; Automobile Driving; Award; Back; Bioinformatics; Biometry; Birth; Blood Pressure; Cardiology; Cardiovascular Diseases; Cardiovascular system; Caring; Characteristics; Child; Clinic; Clinical; Clinical Sciences; Communities; Conceptions; Data; Data Analyses; Data Set; Diagnostic; Disease; Dose; Drug Prescriptions; Echocardiography; Electronic Health Record; Enrollment; Ensure; Environment; Event; Fellowship; Foundations; Functional disorder; Funding; Future; Goals; Grant; Guidelines; Health; Health Policy; Health Services; Health Services Research; Health Technology; Health system; Heart; Heart failure; Hemorrhage; Human Resources; Hypertension; Individual; Infant Care; Informatics; Infrastructure; Institutes; Institution; Internal Medicine; Intervention; Left; Life; Link; Medical center; Medicine; Mentored Patient-Oriented Research Career Development Award; Mentors; Mentorship; Methodology; Minnesota; Morbidity - disease rate; Mus; Myocardial; Myocardial Infarction; NCI Scholars Program; Neonatal; Newborn Infant; Oregon; Outcome; Outcomes Research; Parents; Patient Care; Patients; Pattern; Pharmaceutical Preparations; Population; Productivity; Public Health Schools; Publications; Quality of Care; Research; Research Personnel; Research Project Grants; Research Training; Resistance; Resistant Hypertension; Resources; Risk; Role; Schedule; Source; Specialist; Stimulant; Stroke; Syncope; System; Therapeutic; Time; Training; Translational Research; United States; United States National Institutes of Health; Urban Population; Validation; Work; analytical tool; angiogenesis; base; blood pressure control; cardiovascular health; cardiovascular risk factor; care delivery; career; clinical application; clinical center; clinical decision support; cohort; computerized; cost; design; experience; falls; fascinate; flexibility; health care service organization; health care service utilization; health information technology; health management; hypertension control; hypertension treatment; hypertensive; implantation; implementation science; improved; individualized medicine; innovation; insight; interest; medical schools; medication compliance; medication nonadherence; mortality; professor; programs; provider behavior; scientific computing; skills; statistics; stem cells; success; support tools; tool

PROJECT SUMMARY Resistant hypertension (RH) doubles the risk for adverse cardiovascular outcomes compared to non-resistant hypertension. Defined as having uncontrolled high blood pressure despite the use of at least 3 antihypertensive medications or controlled blood pressure on at least 4 medications, RH is estimated to affect at least 20 million Americans. Importantly, true RH must be differentiated from pseudo-resistant hypertension (pseudo-RH), occurring when blood pressure remains elevated due to extrinsic factors such as suboptimal medication dosing, medication non-adherence, or white-coat effect. Inability to distinguish true RH from pseudo-RH, and tailor treatment accordingly, compounds the risks of overtreating pseudo-RH (e.g. syncope, falls, acute kidney injury) as well as undertreating true RH (e.g. stroke, myocardial infarction). Distinguishing true from pseudo-RH, however, is clinically difficult, in part given the complexities involved in capturing medication adherence patterns and confirming white-coat effect. Therefore, our overall objective is to determine whether electronic health record (EHR) based analytics and tools can be used to close persistent gaps in care for RH. The specific aims of the research project are to: (1) develop and validate a computerized algorithm that uses EHR data to identify RH and distinguish between true and pseudo-RH including its subtypes; (2) develop and optimize a CDS tool for aiding clinicians in the identification and management of apparent RH; and, (3) pilot the implementation of a CDS tool for facilitating care of RH in addition to pseudo-RH and its subtypes. This research promises to enhance our understanding of how health information technology can be leveraged to inform scientific discovery, while also driving high-value care for RH. The proposed work will be conducted as part of a K23 award program, designed provide the advanced research skills and experience needed for the PI to successfully pursue an independent academic career focused on: (i) optimizing value of care (i.e. improved quality at decreased cost); (ii) leveraging health information technology and clinically generated data to gain new insights into disease states; and, (iii) promoting innovation in care delivery using implementation science principles. These efforts will be supported by the outstanding research environment and infrastructure of Cedars-Sinai including the Smidt Heart Institute, the Biostatistics and Bioinformatics Research Center, and the Research Informatics and Scientific Computing Core. Given the strong mentoring, institutional, and infrastructure supports in place, this award is ideally designed to provide the experience needed to launch the PI in his career as an independent investigator and future leader in cardiovascular outcomes research. This addended proposal includes plans for continuity of these research aims during a critical life event for the PI. This calls for the addition of new personnel who will assist with data validation, as well as coordination with external partners. The PI’s institution has provided flexibility for the clinical schedules for both the PI and new personnel to ensure success of this proposal. Further, this proposal outlines mechanisms by which the PI will replace missed training with equivalent opportunities.

项目总结