Design and Testing of a Mobile Cardiovascular Risk Service with Patient Partners

 描述(申请人提供)：心血管疾病(CVD)每天在美国造成2200人死亡，每39秒就有一人死亡。有证据表明，通过更好的风险因素管理，这些死亡是可以预防的，然而，许多风险因素仍然无法控制。以患者为中心的医疗之家(医疗之家)包括自我管理、个性化健康记录和基于团队的护理，已被提出作为缩小护理提供方面的这些差距的一项战略。Cochrane的几篇综述和荟萃分析发现，有证据表明，在初级保健团队中增加药剂师可以改善风险因素控制和医生对指南的遵守。管理保健组织发现，由药剂师管理的集中式心血管风险服务(CVRS)可以降低死亡率。文献中的一个空白是，不知道是否会在非一体化环境中的典型办公室做法中实施全面的CVRS模式。与此同时，对包括疾病管理应用程序在内的移动健康(MHealth)试验的系统审查发现，没有一项试验纳入了与药剂师的沟通，这种缺乏证据是mHealth文献中的一大空白。此应用程序的目标是开发和测试一种启用移动应用程序、药剂师管理的CVR，用于在实践中传播和实施循证指南。除了以患者为设计合作伙伴开发这款应用程序外，我们还将 在具有较大地理、种族和民族多样性的医疗办公室中，进行一项嵌套在NIH正在进行的试验中的多中心个人随机研究。我们将从初级保健办公室随机选择100名患者到mHealth CVR(移动应用程序+网站+药剂师)或仅到CVR(网站+药剂师)，其中55人将来自种族/少数民族。我们的中心假设是，以患者为合作伙伴设计的mHealth CVR将得到实施，并显著提高患者的参与度，从而使用GET与指南和指南优势指标改善对CVD指南的遵从性。这项拟议研究的基本原理是，一种新的mHealth模式，在药剂师的帮助下改善心血管疾病的二级预防，将导致全美卫生系统更广泛地采用。我们的主要目标是：在不同初级保健办公室的前瞻性随机对照试验中，检查mHealth技术传播循证风险降低指南的可行性。我们假设，与对照组相比，随机接受mHealth干预的患者的系统参与度(主要假设)和对心血管疾病二级预防指南(次要假设)的遵守程度将显著提高。这项研究预计将产生以下结果：补充标准CVR的独特移动应用程序功能，更多地参与CVR，以及更多实现指南一致的治疗。

 DESCRIPTION (provided by applicant): Cardiovascular disease (CVD) causes 2,200 deaths in Americans every day with one death every 39 seconds. There is evidence that these deaths can be prevented with better risk factor management, however, many risk factors remain uncontrolled. The Patient-Centered Medical Home (Medical Home) which includes self-management, personalized health records and team-based care, has been proposed as a strategy to reduce these gaps in care delivery. Several Cochrane reviews and meta-analyses have found evidence that adding pharmacists to the primary care team improves risk factor control and physician adherence to guidelines. Managed care organizations have found that a centralized cardiovascular risk service (CVRS) managed by pharmacists can reduce mortality. A gap in the literature is that it is not known whether a comprehensive CVRS model would be implemented in typical office practices in un-integrated settings. Simultaneously, systematic reviews of mobile health (mHealth) trials including disease management apps have found no trial that has incorporated communication with a pharmacist and this lack of evidence is a major gap in the mHealth literature. The objective of this application is to develop and test a mobile app enabled, pharmacist managed CVRS for disseminating and implementing evidence-based guidelines in practice. In addition to developing the app with patients as design partners, we will conduct a multi-center individually randomized study nested within an ongoing NIH trial in medical offices with large geographic, racial and ethnic diversity. We will randomize 100 patients from primary care offices to mHealth CVRS (mobile app + web site + pharmacist) or to CVRS only (web site + pharmacist) of whom 55 will be from racial/ethnic minorities. Our central hypothesis is that the mHealth CVRS designed with patients as partners will be implemented and significantly improve patient engagement, leading to improved CVD guideline adherence using the Get with The Guidelines and Guideline Advantage metrics. The rationale for this proposed study is that a novel mHealth model that improves secondary prevention of CVD with pharmacist assistance will lead to broader adoption by health systems throughout the US. Our primary Aim is: to examine the feasibility of mHealth technology to disseminate evidence- based risk reduction guidelines in a prospective randomized controlled trial among diverse primary care offices. We postulate that system engagement (primary hypothesis) and adherence to guidelines for secondary prevention of CVD (secondary hypothesis) will be significantly greater in patients randomized to the mHealth intervention compared to the control group. This study is expected to produce the following outcomes: unique mobile app features that complement the standard CVRS, increased engagement with a CVRS and increased achievement of guideline- concordant therapy.