Web-based, Patient-centered Approach to CVD Risk-factor Management and Reduction

描述(由申请人提供)： 心血管疾病(CVD)是美洲印第安人(Als)死亡和发病的主要原因。虽然2型糖尿病的存在及其许多行为前驱因素构成了该人群心血管疾病风险的重要组成部分，但在美洲印第安人中几乎没有旨在降低这种心血管疾病风险的基于行为的干预措施。不良的饮食和体力活动习惯以及遵守处方疗法和慢性病管理说明是几种重要的行为，可能会使个人面临更高的心血管疾病风险，进而可能容易受到认知干预。以家庭为基础的护理创新正在涌现，以创建慢性病管理的新范式。医学研究所的报告《跨越质量鸿沟》建议，从主要基于零星的办公室访问的护理转变为基于持续的治愈关系的护理……而不仅仅是面对面的访问。我们认为有必要在美国印第安人中测试这些新的居家认知策略中的一些预防心血管疾病的策略。因此，这一项目的具体目标是： 1.实施一种基于社会认知理论的、基于家庭的远程护理方法，以提高一群没有心血管疾病但有高心血管疾病风险的美国印第安人的忠诚度，他们分别被给予处方的生理疗法和行为指导，以管理他们诊断的高血压、高胆固醇血症和糖尿病； 2.提高这些队列成员对饮食、锻炼和吸烟等行为生活方式先行因素的依从性，这些行为生活方式会影响目标1中描述的生理条件，从而导致心血管疾病风险； 3.为这些美国印第安人研究参与者提供文化定制的、以家庭健康为基础的慢性病管理计划，以及必要的硬件、软件、培训和人员配备，这将以一种改变范式的方式补充他们目前接受护理的途径；以及 4.记录这种干预措施的成本效益，方法是记录每名接受服务的患者的所有计划成本；如果计划被发现有效，则记录指定结果指标的每次变化成本；以及将干预成本与IHS内为改善糖尿病自我管理和预防心血管疾病发作而采用的其他类似计划和策略的成本进行比较。 我们认为，在医疗保健领域，几乎没有什么问题像慢性病管理和家庭护理可能发挥的作用一样迅速出现，包括心血管疾病预防。到2030年，整整一半的美国成年人口将患有慢性病和有线电视。美国印第安人健康的流行病学已经从传染病的模式过渡到慢性病的模式。这一独特的干预措施如果被证明有效，将成为印度和非印度许多其他农村地区的家庭护理和心血管疾病预防的典范。

DESCRIPTION (provided by applicant): Cardiovascular disease (CVD) is a leading cause of mortality and morbidity in American Indians (Als). While the presence of type 2 diabetes, with its many behavioral antecedents, constitutes a significant portion of the CVD risk in this population, there have been few behaviorally-based interventions among American Indians intended to lessen this CVD risk. Poor dietary and physical activity habits and adherence with prescribed therapies and instructions for chronic disease management are several important behaviors that can place an individual at increased risk of CVD and, in turn, possibly be amenable to a cognitive intervention. Innovations in home-based care are emerging to create a new paradigm for chronic disease management. The Institute of Medicine's report, "Crossing the Quality Chasm," has recommended a shift from care based primarily on sporadic office visits toward "care based on continuous healing relationships ... not just face-to-face visits". We feel it warranted to test some of these new home-based, cognitive strategies for cardiovascular disease prevention among American Indians. Therefore, the Specific Aims of this project are to: 1. Implement a Social Cognitive Theory-, home-based, remote care approach to improve the adherence of a cohort of American Indians, free of but at high risk for CVD, with prescribed physiologic therapies and behavioral instructions they have been given to manage, respectively, their diagnosed hypertension, hypercholesterolemia, and diabetes; 2. Improve the adherence of these cohort members with behavioral lifestyle antecedents such as diet, exercise, and smoking, that impact the physiologic conditions described in Aim #1 and, hence, CVD risk; 3. Provide these American Indian study participants with a culturally-tailored, home health-based chronic disease management program, coupled with the requisite hardware, software, training and staffing, that will supplement in a paradigm-changing way the route in which they presently receive care; and 4. Document the cost-effectiveness of this intervention by documenting all program costs per patient served; the cost per change in specified outcome measures if the program is found to be effective; and a comparison of the intervention costs to those of other comparable programs and strategies employed within the IHS to improve diabetes self-management and prevent the onset of CVD. We believe there are few issues in healthcare as rapidly emerging as chronic disease management and the role that home-based care might play, including cardiovascular disease prevention. By the year 2030, fully half of the US adult population will be both chronically diseased and wired. The epidemiology of American Indian health has already transitioned from a model of infectious disease to one of chronic disease. This unique intervention, if proven effective, will serve as a model for home-based care and cardiovascular disease prevention in many other rural settings, both Indian and non-Indian.