Collaborative Behavioral e-Care to Decrease Cardiovascular Risk (e-Compare)

协作行为电子护理可降低心血管风险（电子比较）

• 批准号: 7833997
• 负责人: Beverly Beth Green
• 金额: $ 50万
• 依托单位: KAISER FOUNDATION HEALTH PLAN OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-30 至 2011-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7833997
• 关键词: Address; Adult; Behavior Therapy; Behavioral; Blood Pressure; Body Weight decreased; Cardiovascular Diseases; Caring; Categories; Client satisfaction; Communication; Data; Databases; Diastolic blood pressure; Dietitian; Electronics; Foundations; Health; Healthcare; Heart Diseases; Home Blood Pressure Monitoring; Home environment; Hypertension; Information Systems; Institution; Internet; Intervention; Lead; Life Style; Lipids; Living Costs; Measures; Medication Management; Monitor; Obesity; Online Systems; Overweight; Patients; Pharmaceutical Preparations; Pharmacists; Pharmacy facility; Randomized Controlled Clinical Trials; Risk; Risk Factors; Site; Stroke; Testing; Tobacco use; Weight; base; behavior change; blood pressure regulation; cardiovascular disorder risk; cardiovascular risk factor; chronic care model; comparative effectiveness; cost; cost effectiveness; evidence base; health information technology; health related quality of life; high risk; improved; patient population; primary outcome; secondary outcome; theories

DESCRIPTION (provided by applicant): Overweight and obese adults are more likely to have hypertension and other risk factors for cardiovascular disease (CVD). Evidence-based medication and lifestyle strategies can be used to decrease CVD risk, but little is known about the comparative effectiveness and cost-effectiveness of these strategies and how best to integrate them into routine health care. We have previously demonstrated that Web-based pharmacist medication management intervention can cost-effectively improve HTN control (e-BP: Electronic Communication and Home Blood Pressure Monitoring; R01 HL075263, B. Green, PI). Web-based pharmacy care did not lead to lifestyle behavior change or weight loss. However patients who lost small amounts of weight (2 kg or more) were more likely to have controlled BP (p=.008), regardless of their study group assignment. We propose to use Health Information Technology systems (HIT) to identify asymptomatic patients at moderate risk for CVD and invite them to participate in a theory-based behavioral intervention. Aim #1: We hypothesize that using electronic databases alone, we can identify asymptomatic overweight or obese patients, with uncontrolled BP, and at moderate risk for CVD who might benefit from a behavioral intervention. To test this hypothesis we will measure: Primary outcomes: " The proportion of asymptomatic patients with data for BMI, BP, lipids, and tobacco use " The proportion at moderate risk for CVD (using Framingham risk scores) and the independent effect of obesity on Framingham risk scores. Secondary outcome: " The marginal costs related to moderate risk for CVD with and without obesity. Aim #2: We hypothesize that a dietitian-delivered behavioral intervention, that uses a patient shared EMR and e-communications, can be integrated into routine healthcare and will result in improved control of modifiable CVD risk. To test this hypothesis we will measure: Primary outcomes: " The proportion of patients who agree to participate and complete the intervention " The change in mean systolic and diastolic BP and weight (kg), and a weight loss of 4 kg or more, and the change in Framingham risk score. Secondary outcomes: " Patient satisfaction with the intervention, its effects on health related quality of life (HrQOL) and the cost of delivering the intervention. Adults with high blood pressure (BP) and obesity are at higher risk for heart disease and strokes. A recent study (e-BP) showed that patients who monitored their BP at home and received pharmacist care over the Web had improved BP control. We will be studying whether similar care delivered by dietitians over the Web leads to improved BP control and weight loss.

描述（由申请人提供）： 超重和肥胖的成年人更有可能患有高血压和其他心血管疾病（CVD）的危险因素。循证药物和生活方式策略可用于降低心血管疾病风险，但对这些策略的相对有效性和成本效益以及如何最好地将其整合到常规医疗保健中知之甚少。我们之前已经证明，基于网络的药剂师药物管理干预可以经济有效地改善HTN控制（e-BP：电子通信和家庭血压监测; R 01 HL 075263，B。绿色，PI）。基于网络的药房护理并没有导致生活方式行为的改变或体重减轻。然而，体重减轻少量（2 kg或更多）的患者更有可能控制血压（p= 0.008），无论他们的研究组分配如何。我们建议使用健康信息技术系统（HIT），以确定无症状的患者在中度风险的心血管疾病，并邀请他们参加以理论为基础的行为干预。目标一：我们假设，仅使用电子数据库，我们可以识别无症状的超重或肥胖患者，血压不受控制，并在中度风险的心血管疾病谁可能受益于行为干预。为了验证这一假设，我们将测量：主要结果：“无症状患者的BMI，BP，血脂和烟草使用数据的比例”CVD中度风险的比例（使用Fragrance风险评分）和肥胖对Fragrance风险评分的独立影响。次要结果：“边际成本与伴有和不伴有肥胖的CVD中度风险相关。目标二：我们假设，营养师提供的行为干预，使用患者共享的EMR和电子通信，可以整合到日常医疗保健中，并将导致改善对可改变的CVD风险的控制。为了检验这一假设，我们将测量：主要结局：“同意参与并完成干预的患者比例”平均收缩压和舒张压和体重（kg）的变化，体重减轻4公斤或以上，以及变化弗雷明汉风险评分。次要结局：“患者对干预措施的满意度，其对健康相关生活质量（HrQOL）的影响以及提供干预措施的成本。患有高血压和肥胖的成年人患心脏病和中风的风险更高。最近的一项研究（e-BP）表明，在家监测血压并通过网络接受药剂师护理的患者改善了血压控制。我们将研究营养师通过网络提供的类似护理是否会改善血压控制和体重减轻。