Collaborative Behavioral e-Care to Decrease Cardiovascular Risk (e-Compare)

描述(由申请人提供)： 超重和肥胖的成年人更有可能患有高血压和其他心血管疾病(CVD)的危险因素。循证用药和生活方式策略可以用来降低心血管疾病风险，但人们对这些策略的相对有效性和成本效益以及如何最好地将其整合到常规医疗保健中知之甚少。我们之前已经证明，基于网络的药剂师药物管理干预可以经济有效地改善HTN控制(e-BP：电子通信和家庭血压监测；R01 HL075263，B.Green，PI)。基于网络的药房护理没有导致生活方式行为的改变或体重减轻。然而，体重减轻少量(2公斤或更多)的患者更有可能控制了血压(p=0.008)，无论他们的研究组分配如何。我们建议使用卫生信息技术系统(HIT)来识别无症状的中度心血管疾病风险患者，并邀请他们参与基于理论的行为干预。目的#1：我们假设，仅使用电子数据库，我们就可以识别无症状的超重或肥胖患者，他们的血压没有得到控制，并且有中等风险的心血管疾病，他们可能从行为干预中受益。为了验证这一假设，我们将测量：主要结果：“有BMI、BP、血脂和烟草使用数据的无症状患者的比例”，心血管疾病中等风险的比例(使用Framingham风险评分)，以及肥胖对Framingham风险评分的独立影响。次要结果：“伴有和不伴有肥胖的心血管疾病的中等风险相关的边际成本。目标2：我们假设，营养师提供的行为干预，使用患者共享的EMR和电子通信，可以整合到常规医疗保健中，并将导致改善对可改变的心血管疾病风险的控制。为了验证这一假设，我们将测量：主要结果：“同意参与和完成干预的患者的比例”，平均收缩压和舒张压以及体重(公斤)的变化，体重减轻4公斤或更多，以及弗雷明翰风险评分的变化。次要结果：“患者对干预措施的满意度、其对健康相关生活质量(HRQOL)的影响以及实施干预措施的成本。患有高血压和肥胖的成年人患心脏病和中风的风险更高。最近的一项研究(e-BP)表明，在家中监测血压并通过网络接受药剂师护理的患者改善了血压控制。我们将研究营养师通过网络提供的类似护理是否会改善血压控制和减肥。

DESCRIPTION (provided by applicant): Overweight and obese adults are more likely to have hypertension and other risk factors for cardiovascular disease (CVD). Evidence-based medication and lifestyle strategies can be used to decrease CVD risk, but little is known about the comparative effectiveness and cost-effectiveness of these strategies and how best to integrate them into routine health care. We have previously demonstrated that Web-based pharmacist medication management intervention can cost-effectively improve HTN control (e-BP: Electronic Communication and Home Blood Pressure Monitoring; R01 HL075263, B. Green, PI). Web-based pharmacy care did not lead to lifestyle behavior change or weight loss. However patients who lost small amounts of weight (2 kg or more) were more likely to have controlled BP (p=.008), regardless of their study group assignment. We propose to use Health Information Technology systems (HIT) to identify asymptomatic patients at moderate risk for CVD and invite them to participate in a theory-based behavioral intervention. Aim #1: We hypothesize that using electronic databases alone, we can identify asymptomatic overweight or obese patients, with uncontrolled BP, and at moderate risk for CVD who might benefit from a behavioral intervention. To test this hypothesis we will measure: Primary outcomes: " The proportion of asymptomatic patients with data for BMI, BP, lipids, and tobacco use " The proportion at moderate risk for CVD (using Framingham risk scores) and the independent effect of obesity on Framingham risk scores. Secondary outcome: " The marginal costs related to moderate risk for CVD with and without obesity. Aim #2: We hypothesize that a dietitian-delivered behavioral intervention, that uses a patient shared EMR and e-communications, can be integrated into routine healthcare and will result in improved control of modifiable CVD risk. To test this hypothesis we will measure: Primary outcomes: " The proportion of patients who agree to participate and complete the intervention " The change in mean systolic and diastolic BP and weight (kg), and a weight loss of 4 kg or more, and the change in Framingham risk score. Secondary outcomes: " Patient satisfaction with the intervention, its effects on health related quality of life (HrQOL) and the cost of delivering the intervention. Adults with high blood pressure (BP) and obesity are at higher risk for heart disease and strokes. A recent study (e-BP) showed that patients who monitored their BP at home and received pharmacist care over the Web had improved BP control. We will be studying whether similar care delivered by dietitians over the Web leads to improved BP control and weight loss.