Implementation Strategies for Self-Measured Blood Pressure Monitoring in Racially and Ethnically Diverse Populations (InS2PiRED).

项目摘要/摘要 AHRQ R18提案侧重于评估患者级别和临床级别的策略，以提高 在临床支持下实施自我测量血压(SMBP)监测计划； 具体地说，我们专注于确定在以下情况下加强安全网环境中SMBP监测的方法 许多低收入和/或文化多元化的人群，他们的高血压控制和 结果需要临床护理。SMBP监测是一种以证据为基础、指南推荐的做法 当与临床支持相结合时是最有效的。然而，SMBP监测和临床支持已经有了 由于多层次的障碍，在许多安全网临床环境中的采用有限。加快SMBP的采用 在安全网环境中进行临床支持监测，我们建议在一个综合的、城市的 安全网医疗系统，为50,000名患者提供门诊护理。 在目标1中，我们将共同设计患者层面和临床层面的实施策略，以增加SMBP 由临床团队提供支持的监测。我们将在焦点小组中进行三轮设计会议， 英语、西班牙语和中文高血压患者和临床护理团队成员(例如， 临床医生、药剂师、护士)。我们将设计：(1)两种患者层面的策略(一种低强度策略 提供蜂窝支持的BP监测仪，并就其使用进行培训，而不是增加提醒的高强度策略， 向临床团队传输BP数据的培训，以及在SMBP中与照顾者/同龄人接触的方法 监测活动)；和(2)一项临床一级战略(培训临床冠军和设计电子产品 健康记录[EHR]实施工具)。在目标2中，我们将进行混合类型2的有效性- 实施试验，评估成效和实施结果。总共330名患者将被 登记12个月，随机分为高强度组和低强度组，面向患者的实施 战略；六个初级保健诊所将以阶梯式楔形接受诊所层面的实施战略 设计。对于患者水平的策略，主要的有效结果将是在12岁时改变收缩压 月和主要实施结果将是在12个月内测量的家庭BP值的数量- 一个月的期间。对于我们的临床层面的实施战略，主要的效果结果将在 临床范围内的BP控制和主要实施结果将是记录患者- 收集的BP值。我们的次要结果包括其他临床结果、患者报告的结果和 其他实施成果，从调查、观察、访谈和电子健康记录数据中收集。在目标3中，我们 将对我们的实施战略和干预措施进行成本分析，重点是了解 在我们的实施战略支持下，实施SMBP监测计划的成本。 数据将通过调查、访谈、观察和审查电子健康记录数据来收集。

PROJECT SUMMARY / ABSTRACT This AHRQ R18 proposal focuses on evaluating patient-level and clinic-level strategies to increase implementation of self-measured blood pressure (SMBP) monitoring programs with clinical support; specifically, we focus on identifying approaches to increase SMBP monitoring in safety net settings where many low-income and/or culturally diverse populations who experience worse hypertension control and outcomes receive clinical care. SMBP monitoring is an evidence-based, guideline-recommended practice that is most effective when combined with clinical support. However, SMBP monitoring with clinical support has had limited adoption in many safety net clinical settings due to multi-level barriers. To accelerate adoption of SMBP monitoring with clinical support in safety net settings, we propose to conduct this project in an integrated, urban safety net healthcare system that provides ambulatory care for >50,000 patients. In Aim 1, we will co-design patient-level and clinic-level implementation strategies to increase SMBP monitoring supported by clinical teams. We will conduct three rounds of design sessions in focus groups with English, Spanish, and Chinese-speaking patients with hypertension and clinical care team members (e.g., clinicians, pharmacists, nurses). We will design: (1) two patient-level strategies (a low-intensity strategy of providing cellular-enabled BP monitors and training on its use vs. a high-intensity strategy that adds reminders, training on transmitting BP data to the clinical team, and approaches to engage caregivers/peer in SMBP monitoring activities); and (2) one clinic-level strategy (training of clinical champions and design of electronic health record [EHR] implementation tools). In Aim 2, we will conduct a hybrid type 2 effectiveness- implementation trial and evaluate effectiveness and implementation outcomes. A total of 330 patients will be enrolled for 12 months and randomized to high-intensity vs the low-intensity patient-facing implementation strategy; six primary care clinics will receive the clinic-level implementation strategy in a stepped wedge design. For the patient-level strategy, the primary effectiveness outcome will be change in systolic BP at 12 months and primary implementation outcome will be the number of home BP values measures over the 12- month period. For our clinic-level implementation strategy, the primary effectiveness outcome will be change in clinic-wide BP control and primary implementation outcome will be the frequency of documenting patient- collected BP values. Our secondary outcomes include other clinical outcomes, patient-reported outcomes, and other implementation outcomes, collected from surveys, observations, interviews, and EHR data. In Aim 3, we will conduct a cost-analysis of our implementation strategies and intervention with a focus on understanding the costs of implementing an SMBP monitoring program when supported by our implementation strategies. Data will be collected through surveys, interviews, observations, and review of EHR data.