Designing a Remote Monitoring Intervention for Value & Equity in Hypertension (DRIVE-HTN)

项目总结 这是为Elaine Khoong博士申请职业发展奖，Elaine Khoong博士是哈佛大学的助理教授 加州大学旧金山分校，其职业目标是成为嵌入式医疗系统研究员 应用信息学在安全网系统中进行干预性实施研究，以减少 心血管疾病的差异。该奖项将为她提供培训和研究经验，以： (1)设计专为安全网患者和临床医生量身定做的家庭血压监测方案；(2)试点 评估执行情况和初步成效结果的方案；以及(3)评估 干预行动。为了促进这些活动的成功完成，孔博士组装了一个理想的 由主要导师Urimala Sarkar博士组成的导师团队，他是实施数字健康的专家 改善安全网系统中慢性病管理的解决方案和三位共同导师：考特尼博士 莱尔斯是一位实施科学家，在以人为中心的设计和创新实施方面拥有专业知识 安全网系统；克里斯滕·比宾斯-多明戈博士，心血管流行病学、健康差距、 和建模干预对心血管结果的影响；心脏病专家Dhruv Kazi博士，健康 经济学家，在低资源环境下心血管干预成本效益分析方面的专家。 安全网卫生系统，不成比例地照顾低收入或少数群体，发挥着 在实现国家高血压控制和差距目标方面发挥关键作用。因此，有必要大力发展 并测试可供患者和临床医生在这些系统中使用的实用解决方案。孔博士将 基于以前工作的发现，这些发现表明：(A)在低收入人群中采用数字工具的可用性障碍 (B)在安全网系统中实施创新所面临的挑战 当不考虑工作流和基础设施时。在《目标1》中，孔博士将以人为本 设计用于安全网系统的家庭血压监测程序的设计技术。Dr。 Khoong将领导和评估干预措施在两个城市、安全网诊所的试点实施情况 旧金山的安全网系统，Khoong博士在那里作为普通内科医生执业(Aim 2)。这个 评价将包括执行成果、初步成效成果和费用评价。 (目标3)，这将为设计更大的执行效力提供基础和初步数据 家庭血压监测计划的试验，可以在R01提案中进行评估。 通过有针对性的辅导式培训和课程作业，应聘者将获得以下技能：(1) 以人为本的设计；(2)通过嵌入式设计、实施和评估干预措施 研究模型；(3)成本-效果分析。这些技能将有助于孔博士过渡到 独立性，通过独特的定位来解决患者、临床医生和系统级别的采用障碍 以及实施循证做法，以改善安全网患者的心血管结果。

PROJECT SUMMARY This is an application for a Career Development Award for Dr. Elaine Khoong, an Assistant Professor at the University of California San Francisco, whose career goal is to be an embedded health system researcher that applies informatics to conduct interventional implementation research in safety net systems to reduce disparities in cardiovascular disease. This award will provide her with the training and research experience to: (1) design a home blood pressure monitoring program tailored for safety net patients and clinicians; (2) pilot the program to assess implementation and preliminary effectiveness outcomes; and (3) evaluate the cost of the intervention. To facilitate successful completion of these activities, Dr. Khoong has assembled an ideal mentoring team comprised of primary mentor, Dr. Urmimala Sarkar, an expert in implementing digital health solutions to improve chronic disease management in safety net systems and three co-mentors: Dr. Courtney Lyles, an implementation scientist with expertise in human-centered design and innovation implementation in safety net systems; Dr. Kirsten Bibbins-Domingo, an expert in cardiovascular epidemiology, health disparities, and modeling impact of interventions on cardiovascular outcomes; and Dr. Dhruv Kazi, a cardiologist, health economist, and expert in cost-effectiveness analysis of cardiovascular interventions in low-resourced settings. Safety-net health systems, which disproportionately care for low-income or minority populations, play a pivotal role in achieving national hypertension control and disparities goals. Therefore, it is essential to develop and test pragmatic solutions that can be used by both patients and clinicians in these systems. Dr. Khoong will build on findings from previous work that shows (a) usability barriers to adoption of digital tools in low-income or limited health literate populations and (b) challenges to implementing innovations in safety net systems when workflows and infrastructure are not considered. In Aim 1, Dr. Khoong will employ human-centered design techniques to design a home blood pressure monitoring program for use in safety net systems. Dr. Khoong will lead and evaluate a pilot implementation of the intervention in two urban, safety net clinics within the safety net system in San Francisco where Dr. Khoong practices as a general internist (Aim 2). The evaluation will include implementation outcomes, preliminary effectiveness outcomes, and a cost evaluation (Aim 3), which will provide the foundation and preliminary data to design a larger implementation-effectiveness trial of the home blood pressure monitoring program, which can be assessed in an R01 proposal. Through a focused program of mentored training and coursework, the candidate will gain skills in: (1) human-centered design; (2) design, implementation, and evaluation of interventions through embedded research models; and (3) cost-effectiveness analysis. These skills will facilitate Dr. Khoong’s transition to independence by uniquely positioning her to address patient-, clinician-, and system-level barriers to adoption and implementation of evidence-based practices to improve cardiovascular outcomes in safety net patients.