Nurse Management of Hypertension in Rural Western Kenya

肯尼亚西部农村地区高血压的护士管理

• 批准号: 8234601
• 负责人: Rajesh Vedanthan
• 金额: $ 13.59万
• 依托单位: ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-17 至 2016-07-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8234601
• 关键词: Address; Adult; Africa South of the Sahara; Age; Agency for International Development; Awareness; Biometry; Blood Pressure; Cardiology; Cardiovascular Diseases; Cardiovascular system; Caring; Cause of Death; Cessation of life; Chronic Disease; Clinical Data; Clinical Investigator; Collaborations; Competence; Country; Development; Development Plans; Discipline; Disease Management; Economic Burden; Educational Curriculum; Effectiveness; Engineering; Epidemiology; Evidence based intervention; Focus Groups; Foundations; Future; Goals; Government; HIV; Health; Health Services Accessibility; Human; Human Resources; Hypertension; Impact evaluation; Improve Access; Income; Individual; Intervention; Interview; Kenya; Knowledge; Medicine; Mentors; Methods; Modeling; Morbidity - disease rate; Nurses; Operations Research; Outcome Measure; Outcomes Research; Patients; Performance; Physicians; Prevalence; Prevention; Primary Health Care; Procedures; Process; Qualifying; Qualitative Methods; Research; Resources; Risk Factors; Rural; Science; Solutions; Structure; Testing; Time; Training; United States; Work; base; career; career development; community based participatory research; cost; design; disease diagnosis; experience; health economics; hypertension control; hypertension treatment; implementation research; improved; informant; innovation; medical schools; mortality; multidisciplinary; primary outcome; professor; programs; skills; tool; usability

DESCRIPTION (provided by applicant): Nurse Management of Hypertension in Rural Western Kenya Cardiovascular disease (CVD) is the leading cause of death in sub-Saharan Africa among adults above age 30. The prevalence of hypertension, a major risk factor for CVD, is increasing over time in sub-Saharan Africa, exerting a significant epidemiologic and economic burden on the region. Without adequate control of hypertension, its health and economic burden will increase drastically in the decades ahead. Well established and evidence-based interventions to manage hypertension exist. However, treatment and control rates are low, due to several reasons including lack of an effective chronic disease management platform, inadequate access to essential medicines, and insufficient human resources. One strategy to improve delivery of hypertension care is task-shifting, in which specific tasks are "shifted" from highly qualified health workers to health workers with shorter training and fewer qualifications. Thus, the overall objective of this project is to utilize a multi- disciplinary implementation research approach to optimize delivery of hypertension care in sub-Saharan Africa, focusing on a task-shifting strategy involving nurse management of hypertension. The candidate, Dr. Rajesh Vedanthan, Assistant Professor of Medicine/Cardiology at Mount Sinai School of Medicine, aims to become an independent clinical investigator specializing in implementation research, in order to optimize the delivery of cardiovascular prevention and treatment interventions in low- and middle-income countries. His career development plan, targeted to this career goal, incorporates a multi-disciplinary program carefully designed to provide an intense, closely mentored, implementation research experience in combination with a structured didactic curriculum. The candidate will conduct the proposed research in rural western Kenya in collaboration with the United States Agency for International Development-Academic Model Providing Access to Healthcare (AMPATH) Partnership. Aim 1 is to evaluate facilitators and barriers to implementation of nurse-based management of hypertensive patients, by conducting a rapid assessment procedure. Aim 2 is to utilize a participatory, iterative, human-centered design process to develop a smartphone-based decision support and integrated record-keeping (DESIRE) tool to be used by nurses for hypertension management. Aim 3 is to conduct an impact evaluation of a pilot program for nurse-based management of hypertension to be implemented by AMPATH. Aim 4 is to estimate the nurse workforce requirements for stable, long-term treatment of hypertension using a needs-based workforce estimation model. The specific aims will be accomplished under the guidance of a multidisciplinary team of mentors and advisors with complementary expertise. The project is guided by the following career objectives: 1) develop expertise in qualitative methods and community-based participatory research; 2) develop competence in management sciences and human performance engineering; 3) acquire skills in advanced biostatistical and impact evaluation methods; and 4) acquire knowledge of the methods of operations research and modeling. PUBLIC HEALTH RELEVANCE: Nurse Management of Hypertension in Rural Western Kenya Hypertension is the leading global risk factor for mortality and the global cost of suboptimal blood pressure is estimated to be nearly $1 trillion over the next decade. This project therefore aims to address a singularly critical health and development issue for low- and middle-income countries. The results of this work will add to the emerging body of knowledge on scalable and sustainable strategies for effectively managing hypertension and related chronic diseases in low- and middle-income countries, as well as resource-poor settings in the USA and other high-income countries.

描述（由申请人提供）：肯尼亚西部农村高血压的护士管理心血管疾病（CVD）是撒哈拉以南非洲30岁以上成年人死亡的主要原因。高血压是心血管疾病的主要危险因素，其患病率在撒哈拉以南非洲地区随着时间的推移而增加，对该地区造成了重大的流行病学和经济负担。如果不充分控制高血压，其健康和经济负担将在未来几十年急剧增加。目前已有成熟的循证干预措施来管理高血压。然而，治疗和控制率很低，原因有几个，包括缺乏有效的慢性病管理平台，基本药物供应不足，以及人力资源不足。改善高血压护理服务的一项战略是任务转移，即将具体任务从高素质的卫生工作者“转移”给培训时间较短、资格较少的卫生工作者。因此，本项目的总体目标是利用多学科实施研究方法，优化撒哈拉以南非洲地区高血压护理的提供，重点是涉及高血压护士管理的任务转移策略。候选人Rajesh Vedanthan博士是西奈山医学院医学/心脏病学助理教授，他的目标是成为一名独立的临床研究者，专门从事实施研究，以优化低收入和中等收入国家心血管预防和治疗干预措施的提供。他的职业发展计划，针对这一职业目标，结合了精心设计的多学科计划，以提供一个激烈的，密切指导，实施研究经验结合结构化的教学课程。候选人将与美国国际开发署-提供医疗保健机会的学术模式（AMPATH）伙伴关系合作，在肯尼亚西部农村开展拟议的研究。目的1是评估促进者和实施高血压患者的护士为基础的管理的障碍，通过进行快速评估程序。目的2是利用参与式，迭代，以人为本的设计过程，开发一个基于智能手机的决策支持和综合记录保存（CNORE）工具，用于高血压管理的护士。目的3是对AMPATH实施的以护士为基础的高血压管理试点项目进行影响评估。目的4是使用基于需求的劳动力估计模型来估计稳定、长期治疗高血压的护士劳动力需求。具体目标将在具有互补专长的多学科导师和顾问团队的指导下实现。该项目由以下职业目标指导：1）发展定性方法和基于社区的参与式研究的专业知识; 2）发展管理科学和人类绩效工程的能力; 3）获得先进的生物统计和影响评估方法的技能;和4）获得运筹学和建模方法的知识。 公共卫生关系：肯尼亚西部农村地区高血压的护士管理高血压是导致死亡的主要全球风险因素，在未来十年，全球次优血压的成本估计接近1万亿美元。因此，本项目旨在解决中低收入国家一个极为重要的健康和发展问题。这项工作的结果将增加新兴的知识体系，用于有效管理低收入和中等收入国家以及美国和其他高收入国家资源贫乏环境中的高血压和相关慢性病的可扩展和可持续战略。