Comparing the value of intensive systolic blood pressure treatment implementation strategies

项目总结/摘要 高血压（HTN），影响近8000万美国成年人，社会成本约800亿美元 每年，是心血管疾病（CVD）的主要可改变原因。目前的指南建议 大多数患者的标准收缩压（SBP）治疗目标为<140 mmHg。最高血压 压力干预试验（SPRINT）显示，强化SBP治疗可使CVD事件减少25% （<120 mmHg）。然而，强化SBP治疗可能需要额外的健康 护理资源和实践的变化，因此在现实世界中实施将具有挑战性。 本计画拟：（1）建立并验证一个“混合式”高血压治疗模拟模型， 在符合SPRINT标准的人群样本中确定强化SBP治疗的成本-效果 美国成人，（2）将来自不同卫生系统的本地数据纳入混合血压模型， 比较强化SBP治疗实施策略的成本效益，（3）让当地 利益相关者参与研究设计和交流战略，以及（4）向地方和国家 利益相关者优化SBP强化治疗的实施。核心假设是， 在高心血管疾病风险中，在卫生系统中实施SBP治疗是可行的，具有成本效益 患者与标准治疗相比，即使考虑到当地实施因素。 过去大多数使用计算机模拟方法的研究产生“平均”国家人口估计数， 决策者往往认为这些模型是不透明的“黑箱”。这个项目是创新的，因为它 将模拟方法应用于当地卫生系统层面，使用当地患者数据， 利益攸关方解决实际执行障碍和促进因素。对于SBP强化治疗， 这可能会导致更有效和更安全的实施，同时也减少了CVD的负担， 收缩压升高。 我的职业目标是成为一名首席研究员和专家，专注于使用计算机模拟， 改善医疗服务、质量和人口健康。职业发展计划将 提供培训和指导：（1）先进的计算机模拟方法;（2）分析 来自临床试验、观察性队列、国家调查和卫生系统的个人水平数据; (3)定性方法;（4）计算机模拟研究的传播和交流 结果这种培训将通过课程作业，实践经验和积极的指导来实现。的 指导团队由全国公认的高血压、临床试验、计算机 模拟、成本效益分析、流行病学、定性方法和传播。大学 犹他州的大学为我向独立的过渡提供了一个理想的研究环境。

PROJECT SUMMARY/ABSTRACT Hypertension (HTN), which affects nearly 80 million U.S. adults and costs society approximately $80 billion annually, is the leading modifiable cause of cardiovascular disease (CVD). Current guidelines recommend a standard systolic blood pressure (SBP) treatment goal of <140 mmHg in most patients. The Systolic Blood Pressure Intervention Trial (SPRINT) showed a 25% reduction in CVD events with intensive SBP treatment (<120 mmHg) in high CVD risk adults. However, intensive SBP treatment likely requires additional health care resources and practice changes so it will be challenging to implement in real-world settings. This project proposes to: (1) build and validate a “hybrid” hypertension treatment simulation model to determine the cost-effectiveness of intensive SBP treatment in a population-based sample of SPRINT-eligible U.S. adults, (2) incorporate local data from diverse health systems into the hybrid blood pressure model to compare the cost-effectiveness of intensive SBP treatment implementation strategies, (3) engage local stakeholders in study design and communication strategies, and (4) disseminate results to local and national stakeholders to optimize intensive SBP treatment implementation. The central hypothesis is that intensive SBP treatment implementation in health systems will be feasible and cost-effective in high CVD risk patients compared to standard treatment even when considering local implementation factors. Most past research using computer simulation methods generates “average” national population estimates and the models are often considered opaque “black boxes” by decision makers. This project is innovative as it applies simulation methods to the local health system level, using local patient data, and engages local stakeholders to address practical implementation barriers and facilitators. For intensive SBP treatment, this may result in more efficient and safer implementation, while also reducing the burden of CVD attributed to raised SBP. My career goal is to become a principal investigator and expert focused on the use of computer simulations to improve healthcare delivery, quality, and population health. The proposed career development plan will provide training and mentorship in: (1) advanced computer simulation methods; (2) analysis of individual-level data from clinical trials, observational cohorts, national surveys, and health systems; (3) qualitative methods; and (4) dissemination and communication of computer simulation research results. This training will be achieved through coursework, hands-on experience, and active mentoring. The mentoring team is comprised of nationally recognized experts in hypertension, clinical trials, computer simulation, cost-effectiveness analysis, epidemiology, qualitative methods, and dissemination.!The University of Utah provides an ideal research environment for my transition to independence.