Integrated Technologies for Weight and Blood Pressure Control in Urban Clinics

城市诊所体重和血压控制综合技术

• 批准号: 7382960
• 负责人: GRAHAM A. COLDITZ
• 金额: $ 80.44万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-09-25 至 2011-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7382960
• 关键词: behavioral /social science research tag; behavioral medicine; biomedical automation; blood pressure; clinical research; clinical trials; community health services; cooperative study; cost effectiveness; health care cost /financing; health care service evaluation; health education; human subject; human therapy evaluation; hypertension; interpersonal relations; lifestyle; longitudinal human study; low socioeconomic status; patient oriented research; publications; quality of life; social psychology; social support network; telemedicine; urban area; weight control; weight loss

DESCRIPTION (provided by applicant): I In this proposal, we address the important role of the health care system and social context in the management of weight loss among low income patients with cardiovascular disease. We have partnered with Boston HealthNet, a network of 10 community health centers that provide care to low income and racial/ethnic minority populations, and will conduct a practical clinical trial that will allow us to address issues of effectiveness, generalizability, cost and sustainability and potential for wide-scale dissemination. A key goal of the intervention design has been to use multiple health information technologies to maximize the maintenance of behavior change and the cost-effectiveness of the intervention. 624 Obese, lower income, predominately racial/ethnic minority health center patients who have been diagnosed with hypertension will be enrolled and randomized into one of three conditions: (1) Usual care (UC) plus the NHLBI's Aim for a Healthy Weight brochure; (2) Lifestyle modification with electronic supports (ES), which includes a weight loss 'prescription', skills training and self-monitoring for patients, with all intervention strategies delivered through interactive, phone-based, and print methods, without personal contact but with strong linkages to primary care; and (3) Lifestyle modification with electronic support plus interpersonal and socio- environmental support (ES + SS) provided by community health workers and through linkages to community resources. The conditions have been selected to determine if a multi-level interpersonal component increases the cost-effectiveness of the automated intervention. The primary outcome is weight loss measured at 2 years (intermediate assessments at 6, & 12 months). We aim for a 7% weight loss at 24 months in condition 3 (ES+SS) vs. usual care, based on the changes achieved in the diabetes prevention trial. We assume that condition 2 (ES) will achieve half this level of weight loss over 24 months. 208 patients per condition gives us 80% power after Bonferroni correction to evaluate the weight changes between the three groups. In addition to the primary analysis we will also evaluate the role of mediators and using the RE- AIM theory to implement a multi-faceted dissemination plan and to report on key issues such as moderator characteristics at both practice/clinician and patient/social environmental level.

描述（由申请人提供）：i 在此提案中，我们解决了医疗保健系统和社会环境在低收入患有心血管疾病患者体重减轻的重要作用。我们与波士顿Healthnet合作，这是一个由10个社区健康中心组成的网络，可为低收入和种族/族裔少数民族提供护理，并将进行实用的临床试验，这将使我们能够解决有效性，可推广性，成本和可持续性以及对广泛传播的潜力的问题。干预设计的一个关键目标是使用多种健康信息技术来最大程度地维持行为改变和干预的成本效益。 624肥胖，低收入，主要是被诊断出患有高血压的种族/族裔少数民族健康中心患者，并将其随机分为三种条件之一：（1）常规护理（UC）加上NHLBI的健康体重手册的目标； （2）通过电子支持的生活方式修改，其中包括减肥“处方”，技能培训和患者的自我监控，并通过互动，基于电话和印刷方法提供所有干预策略，而无需个人接触，但与初级保健有很强的联系； （3）通过电子支持以及社区卫生工作者提供的人际关系和社会环境支持（ES + SS）的生活方式修改以及通过与社区资源的联系。选择条件是为了确定多级人际关系成分是否会增加自动干预的成本效益。主要结果是在2年内测量的体重减轻（在6个和12个月的中间评估）。根据糖尿病预防试验的变化，我们的目标是在条件3（ES+SS）和通常的护理情况下24个月的体重减轻7％。我们假设条件2（ES）将在24个月内达到这种体重减轻的一半。每种条件的208名患者在Bonferroni校正后为我们提供80％的功率，以评估三组之间的体重变化。除了主要分析外，我们还将评估调解人的作用，并利用重视理论来实施多方面的传播计划，并报告关键问题，例如在实践/临床医生和患者/社会环境层面上的主持人特征等关键问题。