Home-Based BP Interventions for African Americans

描述(由申请人提供)： 这项研究将进行一项随机试验，以检验两种组织干预措施的有效性和成本效益，这些干预措施旨在改善高危非裔美国家庭护理人群中的BP控制。将进行测试的两种干预措施包括：(I)“基本”干预措施，在患者接受传统的急性后家庭保健时，向护士、医生和患者提供关键的“及时”信息；(Ii)“增强型”干预措施，将患者过渡到以家庭为基础的HTN支持计划，将患者和初级保健医生可获得的信息、监测和反馈延长18个月，超过指数家庭护理入院时间。这些干预措施将相对于常规护理和相互之间进行评估。 将在护士一级进行随机化，护士最初随机分配到特定组(通常护理、基本治疗或加强治疗)将确定在研究期间分配到该特定护士护理的所有新患者的状态。该分析将评估基本和强化干预措施对护理实践和护理过程的影响，对患者高血压管理(如服药依从性)和BP结果的影响，以及对成本的影响。行为和结果将在固定的时间点进行测量，分析将根据选定的护士特征以及患者特征进行调整，包括年龄、性别、血压、合并症和入院时的非正式支持。这些因变量的测量将从主要和次要数据的组合中得出，包括患者记录、患者评估工具、患者访谈、家庭血压监测仪和尿检以及行政档案。回归模型将被用来控制三组护士在可能影响护理实践或护理过程的特征方面的差异。回归模型还将用于控制患者群体之间的差异，这些差异可能会影响行为、服务使用、BP或其他健康结果。对这些模型产生的治疗-对照组差异的估计(对于两种治疗)将进行统计学意义检验，以确定护士和患者水平上观察到的差异在多大程度上可归因于替代干预策略。

DESCRIPTION (provided by applicant): This study will conduct a randomized trial to examine the effectiveness and cost-effectiveness of two organizational interventions aimed at improving BP control among a high-risk, African American home care population. The two interventions to be tested include (i) a "basic" intervention delivering key "just-in-time" information to nurses, physicians and patients while the patient is receiving traditional post-acute home health care; and (ii) an "augmented" intervention transitioning patients to a Home-Based HTN Support Program that extends the information, monitoring and feedback available to patients and primary care physicians for an 18-month period beyond an index home care admission. The interventions will be assessed relative to usual care and to each other. Randomization will occur at the nurse level, and a nurse's initial random assignment to a specific group (usual care, basic treatment or augmented treatment) will determine the status for all new patients allocated to that particular nurse's care for the duration of the study. The analysis will estimate the impact of the basic and augmented interventions on nursing practices and processes of care, on patient hypertension management (e.g. medication adherence) and BP outcomes, and on costs. Behaviors and outcomes will be measured at fixed points in time, and analyses will adjust for selected nurse characteristics, as well as for patient characteristics including age, gender, BP, co-morbidities and informal support at admission. Measures of these dependent variables will be derived from a combination of primary and secondary data, including patient records, patient assessment instruments, patient interviews, home BP monitors and urine tests, and administrative files. Regression models will be used to control for differences among nurses in the three groups with respect to characteristics that might influence practices or processes of care. Regression models also will be used to control for differences across patient groups that might influence behavior, service use, BP or other health outcomes. Estimates of treatment-control group differences (for both treatments) generated by these models will be tested for statistical significance to determine the extent to which observed differences at the nurse and patient levels are attributable to the alternative intervention strategies.