Hypertension Telemanagement in African Americans

非裔美国人的高血压远程管理

• 批准号: 6954654
• 负责人: JOSEPH E FINKELSTEIN
• 金额: $ 71.1万
• 依托单位: UNIVERSITY OF MARYLAND BALTIMORE
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-09-30 至 2009-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6954654
• 关键词: African American; behavioral /social science research tag; cardiovascular disorder education; clinical research; cognitive behavior therapy; computer assisted patient care; computer human interaction; cost effectiveness; health behavior; health care personnel performance; health care service evaluation; health care service utilization; health services research tag; human subject; hypertension; lifestyle; patient care management; patient care personnel relations; patient monitoring device; self care; social support network; telemedicine; therapy compliance

DESCRIPTION (provided by applicant): Studies employing telecommunication technologies have been successful in affecting the major components of chronic disease care including physician practice patterns, patient adherence to therapy, and patient-provider communication. To date there have been no studies evaluating a coordinated approach that simultaneously employs all of these components in an integrated framework linked to primary care practices. In this study we propose to evaluate a multicomponent telemanagement system providing an integrated support both to clinicians and patients in following hypertension treatment guidelines promulgated by JNC 7 Report. The Internet-based Home Automated Telemanagement (HAT) system implements a multi-component chronic disease management model which includes regular patient assessment, disease-specific education, control of patient adherence to treatment plans, promotion of therapeutic lifestyle changes, comprehensive patient-provider communication and computerized decision support. In this proposal we will (1) refine the HAT System to fully implement the multidisciplinary model for telemanagement of hypertension in African Americans (2) evaluate in a randomized controlled trial the magnitude of clinical impact of HAT on hypertension control rates in African Americans and examine cost-effectiveness of the proposed approach. Patients will have the HAT units (Internet-enabled computer connected to a blood pressure monitor and weight scale) installed in their homes and will be instructed how to use it. They will be asked to do self-testing on a regular basis and to answer questions on their computer screen (symptoms, medication use, and other self-care actions). Each HAT session will include (1) patient assessment (objective measurements such as blood pressure and body weight, which are automatically downloaded to the computer, and patient-reported parameters such as patient symptoms and medication use), (2) interpretation and advice according to individualized treatment plan generated by patient's physician, (3) structured hypertension education, (4) patient counseling and health behavior adjustment (based on main constructs of Social Cognitive Theory, such as behavioral capability, self-efficacy, outcome expectations and reinforcement), (5) social support (virtual patient groups, communication with social worker),. Overall, 550 African Americans with hypertension will be enrolled from 50 primary care clinics and will be followed for 18 months. The main study outcomes will be proportion of treated patients that achieve blood pressure goals meeting JNC 7 recommendations, and mean change in systolic and diastolic pressure. We will also explore HAT impact on physician awareness and adherence to JNC 7 guidelines, and patient ability to reach lifestyle modification goals recommended by the JNC 7 Report. Finally, we will perform cost-effectiveness analysis of the HAT intervention in the African American patients with hypertension.

描述（由申请人提供）： 采用电信技术的研究成功地影响了慢性病护理的主要组成部分，包括医师实践模式，患者遵守治疗以及患者提供的沟通。 迄今为止，尚无研究评估一种协调的方法，该方法同时在与初级保健实践相关的综合框架中使用了所有这些组件。在这项研究中，我们建议评估一个多组分的远程管理系统，为遵循JNC 7报告颁布的高血压治疗指南提供综合支持。基于Internet的家庭自动化远程管理（HAT）系统实施了多组分的慢性疾病管理模型，其中包括定期的患者评估，特定于疾病的教育，控制患者遵守治疗计划的控制，促进治疗性生活方式的改变，全面的患者治疗方法，综合患者提供沟通和计算机化的决策支持。在该提案中，我们将（1）完善帽子系统，以充分实施非洲裔美国人的高血压的多学科模型（2）在一项随机对照试验中评估了HAT对非裔美国人高血压控制率的临床影响的幅度，并检查了所提出的方法的成本效益。患者将安装在房屋中的帽子单元（以互联网为基础的计算机连接到血压监测器和体重尺度），并将指示如何使用它。 他们将被要求定期进行自我测试，并在计算机屏幕上回答问题（症状，用药和其他自我保健动作）。 Each HAT session will include (1) patient assessment (objective measurements such as blood pressure and body weight, which are automatically downloaded to the computer, and patient-reported parameters such as patient symptoms and medication use), (2) interpretation and advice according to individualized treatment plan generated by patient's physician, (3) structured hypertension education, (4) patient counseling and health behavior adjustment (based on main constructs of Social Cognitive Theory, such as behavioral capability,自我效能感，结果期望和增强），（5）社会支持（虚拟患者群体，与社会工作者的沟通）。总体而言，50名初级保健诊所将招募550名患有高血压的非洲裔美国人，并将遵循18个月。主要的研究结果将是实现血压目标的治疗患者的比例，这些患者达到了JNC 7建议，并平均变化收缩压和舒张压。我们还将探索对医师意识的影响，并遵守JNC 7指南，以及患者达到JNC 7报告建议的生活方式修改目标的能力。最后，我们将对非裔美国人高血压患者的HAT干预进行成本效益分析。