Maryland Telehome Care Network (MTCN)

描述（由申请人提供）：本申请涉及国家少数民族健康和健康差异中心（NCMHD）健康倡议的社会决定因素的高度优先领域，以获得NIH研究和研究基础设施大机会的资助。该项目是马里兰州医学院（UMSOM）、其既定的教育合作伙伴--位于马里兰州海岸农村的海岸地区健康教育中心（ESAHEC）和位于马里兰州西部农村的西马里兰州地区健康教育中心（WMAHEC）及其农村卫生保健提供合作伙伴--加勒特县卫生部家庭健康机构之间的协作努力（GCHDHHA，位于马里兰州西部农村）和切萨皮克波托马克家庭健康机构（CPHHA，位于马里兰州南部农村）。该项目的总体目标是在健康社会决定因素的广泛背景下，通过建立创新的远程家庭护理（THC）能力，减少居住在农村地区的少数族裔、低收入白色和医疗服务不足的患者在慢性病管理方面的差异。并生成基于理论、科学严谨和高质量的证据，证明该技术能够增强获得专业护理的机会，改善临床结果，并对农村和医疗服务不足社区的医疗资源利用产生积极影响。有了这些广泛的目标，该项目旨在将注意力和资源重新集中在高价值的转化研究方法上，这些方法有助于利用新技术改变医疗保健实践。具体目标是：（1）使用交叉、前瞻性队列设计来测试结构化的90天有时限的THC计划的功效，以增强在代谢综合征/糖尿病（DM）、慢性心力衰竭（CHF）、高血压（HTN）和慢性阻塞性肺病（COPD）的临床管理中获得基于证据的最佳实践;（2）评估90天限时THC计划对医疗资源利用的影响和对生活质量的影响;（3）评估THC的患者和医疗保健专业教育计划，以提高可接受性和满意度。该项目将在马里兰州西部和南部农村县实施，以健康的社会生态理论和社区参与框架为指导，通过GCHDHHA和CPHHA向250名合格患者提供家庭保健服务。根据健康的社会决定因素和健康的社会生态学理论，该项目的措施除了审查个人因素外，还审查社会/人际、社区/机构和社会因素及其与慢性病及其管理的关系。将在基线、30天和90天时评估患者的用药史、急诊科访视和/或住院次数以及生活质量。分析策略包括使用汇总测量、重复测量方差分析和广义估计方程。该项目还有一个严格的过程评估组成部分，以监测和三角测量THC方案的交付情况。该项目的好处包括保留12个工作岗位并创造14个新的工作岗位，促进马里兰州农村社区的经济复苏，以及深入了解电子保健技术在慢性病成本效益管理中的适用性。随着对面临严重健康差距的农村人口的关注，获得护理和临床结果的改善将证明是一项宝贵的投资，有助于我们实现消除健康方面多因素社会决定因素中的健康差距这一国家优先事项。该项目将对我们理解具有成本效益的技术向农村地区提供高质量医疗专业护理的能力产生影响，从而减少少数民族、低收入白色人和居住在农村地区的医疗服务不足者之间的慢性病管理差距。

DESCRIPTION (provided by applicant): This application addresses the National Center on Minority Health and Health Disparities' (NCMHD's) Social Determinants of Health Initiative high priority area for funding under the NIH Research and Research Infrastructure Grand Opportunity. The project is a collaborative effort between the University of Maryland School of Medicine (UMSOM), its established educational partners-Eastern Shore Area Health Education Center (ESAHEC) located in rural Eastern Shore Maryland and the Western Maryland Area Health Education Center (WMAHEC) located in rural Western Maryland, and its rural health care delivery partners- Garrett County Health Department Home Health Agency (GCHDHHA, in rural Western Maryland) and the Chesapeake Potomac Home Health Agency (CPHHA, in rural Southern Maryland). The broad goals of the project are to reduce disparities, within the broad context of social determinants of health, in chronic disease management among minority, low-income white, and medically underserved patients residing in rural geographies by building an innovative telehome care (THC) capacity and generating theoretically-based, scientifically rigorous and high quality evidence on the ability of the technology to enhance access to specialty care, improve clinical outcomes, and positively impact medical resource utilization in rural and medically underserved communities. With these broad goals, the project aims to refocus attention and resources towards high value translational research approaches that help transform health care practices using novel technologies. The specific aims are: (1) To use a cross-over, prospective cohort design to test the efficacy of a structured 90 day time-limited THC program to enhance access to evidence based best practices in the clinical management of Metabolic Syndrome/Diabetes Mellitus (DM), Chronic Heart Failure (CHF), Hypertension (HTN), and Chronic Obstructive Pulmonary Disease (COPD); (2) To evaluate the impact of this 90 day time-limited THC program on medical resource utilization and effects on Quality of Life; and, (3) To evaluate a patient and health care professional education program on THC to enhance acceptability and satisfaction. The project, guided by the socioecological theory of health and the community based participatory framework, will be implemented in rural Western and Southern Maryland counties among 250 eligible patients receiving home health care through GCHDHHA and CPHHA. Informed by the social determinants of health and the socioecological theory of health, the project's measures examine, besides individual-level factors, social/ interpersonal, community/institutional, and societal factors and their relationships to chronic diseases and its management. The patients will be assessed at baseline, 30-days, and 90-days on medication history, number of emergency department visits and/or hospitalizations, and Quality of Life. The analytical strategy includes the use of summary measures, repeated measure ANOVA, and generalized estimating equations. The project also has a rigorous process evaluation component to monitor and triangulate delivery of the THC program. Benefits of the project include the preservation of 12 jobs and creation of 14 new jobs, the promotion of economic recovery among rural communities in Maryland, and insights into the applicability of e-health technologies in the cost-effective management of chronic diseases. With the focus on rural populations facing serious health disparities, evidence of improved access to care and clinical outcomes will prove to be an invaluable investment towards us achieving the national priority of elimination of health disparities within the multi-factorial social determinants of health perspective. The project will have an impact on our understanding of the ability of cost-efficient technologies to deliver high quality medical specialty care to rural settings, thus reducing chronic disease management disparities among the minorities, low-income white, and the medically underserved residing in rural settings.