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型糖尿病及其许多行为前因的存在构成了这一人群中CVD风险的重要部分，但在美国印第安人中很少有旨在减少这种CVD风险的基于行为的干预措施。不良的饮食和身体活动习惯以及遵守规定的治疗方法和慢性疾病管理说明是几种重要的行为，这些行为可能会使个体患CVD的风险增加，反过来可能会受到认知干预。家庭护理的创新正在出现，为慢性病管理创造了一个新的范例。医学研究所的报告，“跨越质量鸿沟”，建议从主要基于零星办公室访问的护理转变为“基于持续愈合关系的护理......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一些新的以家庭为基础的心血管疾病预防认知策略。因此，该项目的具体目标是： 1.实施社会认知理论-以家庭为基础的远程护理方法，以提高一组美洲印第安人的依从性，这些印第安人没有心血管疾病，但有高风险，他们分别接受了处方的生理治疗和行为指导，以管理他们诊断的高血压、高胆固醇血症和糖尿病; 2.改善这些队列成员对行为生活方式前因（如饮食、锻炼和吸烟）的依从性，这些行为生活方式前因影响目标1中描述的生理状况，因此影响CVD风险; 3.为这些美洲印第安人研究参与者提供文化定制的，基于家庭健康的慢性病管理计划，以及必要的硬件，软件，培训和人员配备，这将以改变范式的方式补充他们目前接受护理的途径; 4.通过记录每位患者的所有计划成本，记录该干预措施的成本效益;如果发现该计划有效，则记录指定结局指标每次变化的成本;并将干预成本与IHS内采用的其他可比计划和策略进行比较，以改善糖尿病自我管理并预防CVD的发生。 我们认为，在医疗保健领域，很少有问题能像慢性病管理和家庭护理（包括心血管疾病预防）可能发挥的作用那样迅速出现。到2030年，整整一半的美国成年人口将同时患有慢性疾病和有线电视。美洲印第安人健康的流行病学已经从传染病模式转变为慢性病模式。这种独特的干预措施，如果被证明是有效的，将成为许多其他农村地区，包括印度和非印度的家庭护理和心血管疾病预防的模式。

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.