Home Blood Pressure Telemonitoring and Case Management to Control Hypertension

家庭血压远程监测和病例管理以控制高血压

• 批准号: 7816333
• 负责人: KAREN L MARGOLIS
• 金额: $ 1.68万
• 依托单位: HEALTHPARTNERS INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-06-01 至 2010-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7816333
• 关键词: Address; Adult; Agreement; American; Antihypertensive Agents; Arts; Blinded; Blood Pressure; Cardiovascular system; Caring; Case Management; Case Manager; Chronic; Classification; Client satisfaction; Clinic; Clinical; Communication; Computerized Medical Record; Control Groups; Data; Diabetes Mellitus; Education; Enrollment; Ensure; Equipment; Event; Formularies; Future; Goals; Guidelines; Home environment; Hypertension; Information Systems; Intervention; Kidney Diseases; Length; Maintenance; Measurement; Measures; Medical; Methods; Modeling; Modems; Office Visits; Outcome; Patients; Performance; Pharmaceutical Preparations; Pharmacists; Phase; Physicians; Population Heterogeneity; Primary Care Physician; Primary Health Care; Problem Solving; Process; Protocols documentation; Randomized; Randomized Controlled Clinical Trials; Randomized Controlled Trials; Reading; Research; Research Design; Secure; Self Management; Telephone; Testing; Therapeutic; Therapeutic Intervention; Time; Touch sensation; Visit; Writing; base; blood pressure regulation; care systems; chronic care model; cost; effective intervention; empowered; follow-up; hypertension control; hypertension treatment; improved; innovation; new technology; patient population; population based; prevent; primary care setting; public health relevance; satisfaction; social; technological innovation; treatment as usual; web site

DESCRIPTION (provided by applicant): Blood pressure (BP) is controlled to recommended levels in only 1 in 3 people with hypertension, and there has been little improvement since the late 1980s, despite advances in evidence to support aggressive hypertension control, and availability of many new and effective antihypertensive drugs. It is clear that meaningful and sustained improvement in hypertension control will likely require fundamental changes in the current physician-centered office-visit based model of caring for hypertension. In this project we develop and implement an intervention that takes advantage of new technology and team models of care to improve BP measurement and control, solving the problems that have limited the application of case management approaches to hypertension care improvement. The study will take place in a diverse population of adults with hypertension cared for in a real-world primary care setting. The Telemonitoring Intervention (TI) integrates 2 innovative components: First, home BP measures are done using state-of-the-art modem-enabled automated equipment that internally stores and electronically transmits BP data through a simple touch-tone telephone connection to a secure web site. Second, a pharmacist case manager integrated with the primary care team through a jointly used electronic medical record (EMR) and formulary adjusts antihypertensive therapy using an approved written protocol, under a collaborative practice agreement with physicians. Treatment decisions are based on home BP data and are discussed and communicated to patients in telephone visits with the pharmacist case manager. Two-way communication between the pharmacist case manager and the patient's primary care team is assured by using a shared EMR and by additional secure messaging of the results of every pharmacist encounter to the primary care team. To assess the impact of the TI on hypertension control, patient satisfaction, and costs of care, we will conduct a cluster-randomized trial, assigning 16 primary care clinics and 450 of their nested patients with uncontrolled hypertension to either a Usual Care (UC) control group or TI. Blood pressure outcomes in both groups will be determined at baseline, 6, 12 and 18 months in an identical and blinded fashion in a research clinic separate from the clinical setting where patients received their medical care. We hypothesize that guideline BP control will be achieved at 6 months and maintained at 12 months in more than 60% of patients from TI clinics, compared to < 40% in patients from UC clinics. We will compare satisfaction with care and costs in the TI and UC groups. The TI has the potential to improve hypertension control for millions of patients, and could be implemented widely in diverse and large patient populations based on performance in this randomized trial. The results of the project will have important implications for future efforts to improve care provided to many of the estimated 20 million Americans with uncontrolled hypertension. PUBLIC HEALTH RELEVANCE: In this project we develop and implement an intervention to improve hypertension control in a primary care setting that takes advantage of new technology (home blood pressure telemonitoring) and team models of care (pharmacist case management). The results of the project will have important implications for future efforts to improve care provided to many of the estimated 20 million Americans with uncontrolled hypertension.

描述（由申请人提供）：只有三分之一的高血压患者血压被控制在推荐水平，自20世纪80年代末以来，尽管有证据支持积极控制高血压，并且有许多新的有效的抗高血压药物可用，但血压（BP）几乎没有改善。很明显，高血压控制的有意义和持续的改善可能需要从根本上改变目前以医生为中心的基于办公室就诊的高血压护理模式。在这个项目中，我们开发并实施了一种干预措施，利用新的技术和团队护理模式来改善血压测量和控制，解决了限制病例管理方法应用于高血压护理改善的问题。该研究将在现实世界初级保健环境中护理的不同成年高血压患者中进行。远程监测干预（TI）集成了2个创新组件：首先，家庭BP测量使用最先进的调制解调器支持的自动化设备完成，该设备内部存储并通过简单的按键式电话连接到安全网站以电子方式传输BP数据。其次，药剂师病例管理人员通过联合使用电子病历（EMR）和处方，与初级保健团队结合，根据与医生的合作实践协议，使用经批准的书面协议调整降压治疗。治疗决定是基于家庭血压数据，并在与药剂师病例管理员的电话访问中与患者进行讨论和沟通。药剂师病例管理人员和患者初级保健团队之间的双向沟通是通过使用共享的电子病历和通过向初级保健团队发送每次药剂师遇到的结果的额外安全消息来保证的。为了评估TI对高血压控制、患者满意度和护理成本的影响，我们将进行一项集群随机试验，将16家初级保健诊所和450名嵌套的未控制高血压患者分配到常规护理（UC）对照组或TI组。两组的血压结果将在基线、6个月、12个月和18个月时以相同的盲法在一个研究诊所中确定，该诊所与患者接受医疗护理的临床环境分开。我们假设超过60%的TI诊所患者在6个月时可以达到指导血压控制，并在12个月时保持血压控制，而UC诊所患者的这一比例低于40%。我们将比较TI和UC组的护理满意度和成本。TI有可能改善数百万患者的高血压控制，并且可以根据该随机试验的表现在不同和大型患者群体中广泛实施。该项目的结果将对未来努力改善对大约2000万未控制高血压的美国人中的许多人的护理具有重要意义。公共卫生相关性：在这个项目中，我们开发并实施了一项干预措施，利用新技术（家庭血压远程监测）和团队护理模式（药剂师病例管理），改善初级保健环境中的高血压控制。该项目的结果将对未来努力改善对大约2000万未控制高血压的美国人中的许多人的护理具有重要意义。