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

确定在初级保健中实施基于团队的家庭血压监测的成功策略

• 批准号: 10474081
• 负责人: Kevin Fiscella
• 金额: $ 66.74万
• 依托单位: UNIVERSITY OF ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-10 至 2026-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10474081
• 关键词: Abbreviations; Address; Adopted; Adoption; Advisory Committees; African American population; Ambulatory Blood Pressure Monitoring; Attitude; Cardiovascular Diseases; Caring; Clinical; Cluster randomized trial; Code; Cost Analysis; Data; Diagnosis; Effectiveness; Elements; Evaluation; Evidence based practice; Glossary; Goals; Home Blood Pressure Monitoring; Hybrids; Hypertension; Infrastructure; Knowledge; Leadership; Learning; Length; Low income; Maintenance; Manuals; Measures; Medical; Methods; Modeling; Motivation; Office Visits; Outcome; Patient Education; Patients; Performance; Personal Growth; Phase; Practical Robust Implementation and Sustainability Model; Primary Health Care; Problem Solving; Procedures; Process; Progress Reports; Publishing; Quality of life; Reach Effectiveness Adoption Implementation and Maintenance; Readiness; Reading; Reporting; Research Personnel; Resources; Risk Factors; Role; Science; Site; Testing; Time; TimeLine; Training; United States; Work; base; cardiovascular disorder prevention; follow-up; formative assessment; hypertension control; implementation cost; implementation evaluation; implementation process; implementation strategy; improved; improved functioning; meetings; minority patient; modifiable risk; patient oriented; primary outcome; racial disparity; recruit; secondary outcome; skills; translatable strategy

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.

高血压是预防心血管疾病最重要的、医学上可改变的单一危险因素 疾病发生在美国。控制高血压对于延长人类寿命和提高生活质量至关重要 美国并解决心血管疾病方面的种族差异。然而，国家进步 高血压的控制已陷入停滞。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。迫切需要团队—— 以患者为中心的护理模式。基于团队的家庭血压监测 (TB-HBPM) 代表了一种在初级保健中广泛未得到充分利用的循证实践。需要策略 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 策略必须让患者和临床医生参与实施过程，并为患者及其患者提供帮助 护理团队拥有实施和维持 TB-HBPM 所需的知识、技能、资源和数据。 值得注意的是，战略必须解决财务可持续性问题。该提案的主要目标是确定 并严格评估实施和维持 TB-HBPM 的可转化策略 初级保健。为了实现这一目标，我们将从一个地点招募七个诊所，以治疗高血压 控制不是最理想的。这些做法主要服务于低收入和少数族裔患者。在第一阶段（R61）， 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， 实施、可持续性和评估（目标 1）。在第一阶段，我们将评估具体障碍并 在这些实践中实施 TB-HPBM 的促进者。基于这些具体实践的障碍，我们将 使用实用、稳健、实施和可持续性模型 (PRISM) 实施战略。在 第 2 阶段 (R33)，我们将使用混合类型 2、阶梯式楔形集群来部署这些实施策略 随机试验（目标 2）。实施策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 使用覆盖范围、有效性、采用、维护 (RE-AIM) 框架（目标 3）的策略。我们的主要 结果将是 HTN 控制和患者使用 HBPM。次要结果将包括 60天内就诊的血压未受控制的患者，由团队制定团队章程 （采用），以及基于成本分析的财务可持续性（维护）。我们将用现实的评价 测试实施策略背后的理论假设（目标 4）。这种混合方法 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发展 实施成功的 HTN 管理模式，并提供更广泛的路线图 在初级保健中实施 TB-HBPM。