Identifying Successful Strategies for Implementing Team-Based Home Blood Pressure Monitoring in Primary Care

高血压是预防心血管疾病的唯一最重要的、医学上可改变的危险因素 美国的疾病。控制高血压对改善老年人的生活时间和质量至关重要 在美国和解决心血管疾病方面的种族不平等问题上取得了重大成就。然而，国家在以下方面取得了进展 控制高血压已经停滞不前。美国目前的高血压护理模式依赖于 几乎完全由临床医生驱动的办公室访问，已被证明是不够的。迫切需要一支团队- 以病人为中心的护理模式。团队家庭血压监测(TB-HBPM) 代表了一种循证做法，这种做法在初级保健中普遍未得到充分利用。战略是必要的 以促进其在初级保健中的采用。根据已公布的采用TB-HBPM的障碍，成功 战略必须让患者和临床医生参与实施过程，并为患者和他们提供 拥有实施和维持结核病-HBPM所需的知识、技能、资源和数据的护理团队。 值得注意的是，战略必须解决财务可持续性问题。这项提案的主要目标是确定 并严格评估实施和维持结核病-HBPM的可翻译战略 初级保健。为了实现这一目标，我们将从高血压的一个地点招募七名医生 控制不是最优的。这些做法主要服务于低收入和少数族裔患者。在阶段1(R61)中， 我们将召集一个由患者、执业人员和临床医生组成的指导委员会来指导规划， 执行、可持续性和评价(目标1)。在第一阶段，我们将评估具体的障碍和 在这些做法中实施结核病--氟氯烃管理的促进者。基于这些特定于实践的障碍，我们将 使用实用、稳健、实施和可持续发展模式(PRISM)实施战略。在……里面 第2阶段(R33)，我们将使用混合型2阶梯楔形群集部署这些实施战略 随机试验(目标2)。实施战略将包括患者和团队培训、可操作的数据 提供给团队，并采用新的计费代码。我们将评估实施的影响 使用REACH、有效性、采用、维护(RE-AIM)框架的战略(目标3)。我们的初选 结果将是HTN的控制和患者使用HBPM。次要结果将包括 60天内就诊的血压失控患者，按团队建立团队章程 (采用)和基于成本分析的财务可持续性(维护)。我们将使用现实主义的评估 检验作为实施战略基础的理论假设(目标4)。这种混合方法 这种方法将使我们能够为其他环境开发可转移的经验教训。我们的发现将推动科学的发展 关于实施成功的HTN管理模式，并提供走向更广泛的路线图 在初级保健中实施结核病-HBPM。

Hypertension is the single most important, medically modifiable risk factor for the prevention of cardiovascular disease in the United States. Control of hypertension is critical to improving the length and quality of life in the United States and for addressing racial disparities in cardiovascular disease. Yet, national progress in controlling hypertension has stalled. The current model for hypertension care in the United States, which relies nearly exclusively on clinician-driven office visits, has proven inadequate. There is an urgent need for team- based, patient-centered models of care. Team-based home blood pressure monitoring (TB-HBPM) represents an evidence-based practice that is widely underused in primary care. Strategies are needed to promote its adoption in primary care. Based on published barriers to adoption of TB-HBPM, successful strategies must engage patients and clinicians in the implementation process, and provide patients and their care teams with the knowledge, skills, resources, and data needed to implement and sustain TB-HBPM. Notably, strategies must address financial sustainability. The primary goal of this proposal is to identify and rigorously evaluate translatable strategies for implementing and sustaining TB-HBPM within primary care. To accomplish this aim, we will recruit seven practices from a single site where hypertension control is suboptimal. These practices serve predominately low-income and minority patients. In phase1 (R61), we will convene a steering committee that includes patients, practice staff, and clinicians to guide planning, implementation, sustainability, and evaluation (Aim 1). During phase 1, we will assess the specific barriers and facilitators to implementing TB-HPBM within these practices. Based on these practice-specific barriers, we will operationalize strategies using the Practical, Robust, Implementation, and Sustainability Model (PRISM). In phase 2 (R33), we will deploy these implementation strategies using a hybrid type-2, stepped wedge cluster randomized trial (Aim 2). Implementation strategies will include patient and team training, actionable data provided to the teams, and adoption of new billing codes. We will assess the impact of implementation strategies using the Reach, Effectiveness, Adoption, Maintenance (RE-AIM) framework (Aim 3). Our primary outcomes will be HTN control and patient use of HBPM. Secondary outcomes will include the proportion of patients with uncontrolled BP who are seen within 60 days, establishment of team charters by teams (adoption), and financial sustainability based on a cost analyses (maintenance). We will use realist evaluation to test theoretical assumptions underlying the implementation strategies (Aim 4). This mixed-methods approach will allow us to develop transferable lessons for other settings. Our findings will advance the science on implementation of successful HTN management models and provide a roadmap towards broader implementation of TB-HBPM in primary care.