Bring it Down San Francisco: Harnessing cloud-based technology to improve hypertension management in a low-income underserved population

项目摘要/摘要 这是一份为Valy Fontil博士申请K23指导患者导向职业发展奖的申请书 加州大学旧金山分校普通内科助理教授 在以卫生系统为基础的战略实施研究中确立自己作为青年研究员的地位 改善服务不足的高危人群的高血压控制。这个K23奖项将为他提供 在12个安全网诊所对一项高血压管理发明进行必要的支持评估并测试一项新的 技术支持的介入，使患者参与并实现患者之间的共享决策 和提供者优化就诊频率、治疗强度和用药依从性 高血压。为了实现这些目标，丰蒂尔博士组建了一个由多学科组成的指导团队，成员包括 主要导师Kirsten Bibbins-Doming博士，心血管流行病学、卫生学方面的著名专家 差异研究和仿真建模，以及两位共同导师：著名的 心血管流行病学家，在临床决策、决策分析和使用 改善健康的新兴技术；以及生物统计部门负责人Charles McCulloch博士 加州大学旧金山分校，纵向数据高级统计分析专家。 照顾高危人群的安全网医疗机构必须在以下方面发挥关键作用 实现改善BP控制和缩小HTN差距的国家优先事项。因此，至关重要的是， 开发和测试这些医疗保健系统可以在其资源范围内采用的实用解决方案 约束条件。Fontil博士将建立在他之前在模拟建模和真实世界飞行员工作中的发现 采取干预措施，重点优化护理的两个关键流程(就诊频率、强化治疗和 服药依从性)，可以将血压控制提高到80%以上。首先，他将评估特定于种族的 安全网诊所的卫生系统干预(目标1和2)对改善这些过程的影响。然后他 将调整和测试技术支持的干预措施，以确定改善患者这些过程的可行性 安全网诊所(目标3)。拟议的研究将提供所需的基础和补充信息。 设计一项技术支持干预的随机对照试验，以改善总体BP控制和 减少英国石油公司在整个安全网医疗系统联盟中的控制种族差异。这将形成 这是我未来R01提案的基础。 通过有重点的导师培训和课程作业计划，候选人将获得高级技能和 (1)为保健服务研究使用和分析电子健康记录数据方面的培训；(2) 计算机微模拟建模的高级技术，以及(3)基本概念和技能 数据科学、技术和医疗保健的交叉。

PROJECT SUMMARY/ABSTRACT This an application for a K23 Mentored Patient-Oriented Career Development Award for Dr. Valy Fontil, an Assistant Adjunct Professor in General Internal Medicine at the University of California San Francisco who is establishing himself as a young investigator in implementation research of health systems-based strategies to improve hypertension control in underserved, high-risk populations. This K23 award will provide him with the necessary support evaluation of a hypertension management invention in 12 safety-net clinics and test a novel technology-enabled intervention that engages patients and enables shared decision-making between patients and providers to optimize visit frequency, treatment intensification, and medication adherence for treatment of hypertension. To achieve these goals, Dr. Fontil has assembled a multi-disciplinary mentoring team comprised of a primary mentor, Dr. Kirsten Bibbins-Doming, a renowned expert in cardiovascular epidemiology, health disparities research, and simulation modeling, and two co-mentors: Dr. Mark Pletcher, renowned cardiovascular epidemiologist with added expertise in clinical decision-making, decision analysis, and use of emerging technology for improving health; and Dr. Charles McCulloch, Head of the Division of Biostatistics at UCSF and expert in advanced statistical analysis of longitudinal data. Safety-net healthcare institutions, which care for our highest-risk populations, must play a pivotal role in achieving national priorities for improved BP control and reducing HTN disparities. Therefore, it is essential to develop and test practical solutions that these healthcare systems can employ within their resource constraints. Dr. Fontil will build on findings from his previous work in simulation modeling and real-world pilot intervention to focus on optimizing two key processes of care (visit frequency, treatment intensification, and medication adherence) that can improve BP control to upward of 80%. First, he will evaluate race-specific effects of a health system intervention in safety net clinics (Aims 1&2) on improving these processes. Then he will adapt and test a technology-enabled intervention for feasibility of improving these processes in patients at safety-net clinics (Aim 3). The proposed research will provide the foundation and additional information needed to design a randomized controlled trial of a technology-enabled intervention to improve overall BP control and reduce racial disparities in BP control across a consortium of safety-net healthcare systems. This will form the basis of my future R01 proposal. Through a focused program of mentored training and coursework, the candidate will gain advanced skills and expertise in (1) training in using and analyzing electronic health record data for health services research, (2) advanced techniques in computer microsimulation modeling, and (3) foundational concepts and skills at the intersection of data science, technology and healthcare.