Heart-Related Multiple Chronic Conditions in Primary Care: Behavioral Technology

项目摘要/摘要 此R01提案旨在测试一种计算机技术(C-国际象棋)，它提供了一种通用的方法来处理多个 慢性病(MCC)。在医疗保险受益人中，65%的人有3个或更多的MCC，23%的人有5个或更多 更多。患有MCC的人占联邦医疗保险支出的90%。MCC通常在初级保健中得到解决。 初级保健工作量的增加通常会阻止临床医生解决自我管理技能问题 然而，设定目标和跟踪等技能对于管理慢性病很重要。 认知行为疗法、自我监控和社会支持等行为干预可以改善 自我管理技能和健康结果，以及技术可以有效地提供这种干预措施。 C-CHESS(慢性病健康促进支持系统)提供了工具、动力和 社会支持，帮助MCC患者更好地管理他们的病情，包括出现的互动 在各种条件的组合中。C-象棋建立在成功行为干预的元素之上：Long 持续时间、持续外展、监测、提示、行动计划、解决问题、自我调整和同行 支持。C-CHESS通过及时传达患者状态的重要变化来解决临床医生的负担 通过改善患者自我管理，减少初级保健就诊次数。C-国际象棋将在一个 在威斯康星州南部的5家初级保健诊所进行的随机临床试验。这项试验将涉及330名年龄在 65岁及以上，有3种或全部4种情况：高血压、高脂血症、糖尿病和骨关节炎。 患者将被分配到照常治疗+C-棋或照常治疗+上网。这个 试用期为12个月，随访6个月。这项试验的目的是找出两者之间的差异 在生活质量和初级保健使用方面的群体。其次，该试验的目的是检测两者之间的差异 分组：(1)测量每种情况(血压、低密度脂蛋白、血糖和疼痛)；(2)综合评分 这结合了单独的测量方法；以及(3)患者有8种症状的数量。试验将 还要检查可能调节干预措施和结果之间关系的因素：坚持 药物和预约就诊，以及自决理论的三个组成部分(患者 能力、与他人的关系和动力)。最后，审判将审查可能影响 C级国际象棋与结果之间关系的强度：性别、年龄和慢性病的数量。 如果成功，C-国际象棋将在改善健康和减轻初级保健负担方面发挥很大作用， 不断增长、昂贵的患者群体，他们的病情现在没有得到很好的解决。成功 实施可能意味着从以地点为基础、专注于医疗管理的护理转变，以及 定期护理专注于帮助患者通过建立在经过验证的 有效的行为干预原则使患者和临床医生都易于使用。

PROJECT SUMMARY/ABSTRACT This R01 proposal seeks to test a computer technology (C-CHESS) that offers a common approach to multiple chronic conditions (MCCs). Among Medicare beneficiaries, 65% have 3 or more MCCs and 23% have 5 or more. People with MCCs account for 90% of Medicare spending. MCCs are usually addressed in primary care. Increasing workloads in primary care often prevent clinicians from addressing self-management skills with patients, though such skills as goal-setting and tracking are important for managing chronic conditions. Behavioral interventions such as cognitive behavioral therapy, self-monitoring, and social support can improve both self-management skills and health outcomes, and technology can effectively deliver such interventions. C-CHESS (Chronic Condition Health Enhancement Support System) provides tools, motivation, and social support to help patients with MCCs better manage their conditions, including interactions that arise among the combination of conditions. C-CHESS is built on elements of success behavioral interventions: long duration, ongoing outreach, monitoring, prompts, action planning, problem solving, self-tailoring, and peer support. C-CHESS addresses clinician burden by promptly communicating important changes in patient status and—by improving patient-self-management—reducing primary care visits. C-CHESS will be tested in a randomized clinical trial in 5 primary care clinics in southern Wisconsin. The trial will involve 330 patients age 65 and older with 3 or all 4 of these conditions: hypertension, hyperlipidemia, diabetes, and osteoarthritis. Patients will be assigned to treatment as usual + C-CHESS or treatment as usual + access to the Internet. The trial will last 12 months with a 6-month follow up. The goal of the trial is to detect differences between the 2 groups in quality of life and use of primary care. Secondarily, the trial aims to detect differences between the 2 groups in (1) measures for each condition (blood pressure, LDL, blood sugar, and pain); (2) a composite score that combines the individual measures; and (3) number of symptoms patients have from a list of 8. The trial will also examine factors that may mediate the relationship between the interventions and outcomes: adherence to medications and appointment attendance, as well as the 3 components of self-determination theory (patient competence, relatedness to others, and motivation). Finally, the trial will examine factors that may affect the strength of the relationship between C-CHESS and outcomes: gender, age, and number of chronic conditions. If successful, C-CHESS will improve the health and reduce the burden on primary care of a large, growing, expensive group of patients whose conditions are not now well addressed. Successful implementation may point to a shift from care that is place-based, focused on medical management, and periodic to care focused on helping patients manage their own conditions through a system built on the proven principles of effective behavioral interventions made easy for both patients and clinicians to use.