Using a Telemedicine System to Promote Patient Care Among Underserved Individuals

使用远程医疗系统促进服务不足的个人的患者护理

• 批准号: 7359938
• 负责人: Alfred Anthony Bove
• 金额: $ 41.4万
• 依托单位: TEMPLE UNIV OF THE COMMONWEALTH
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-09-13 至 2010-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7359938
• 关键词: Using; Telemedicine; System; Promote; Patient

DESCRIPTION (provided by applicant): Hypertension affects more than 65 million people in the US with African Americans disproportionably affected. Untreated hypertension is associated with an increased risk for myocardial infractions, sudden death, stroke, and renal failure. Despite the importance of controlling hypertension and available therapy, the clinical application of well-established guidelines has been disappointing. Inadequate blood pressure control remains all too common. To advance care for chronic conditions such as hypertension, the patient-provider relationship needs to mature into a Partnership. Patient empowerment must be increased through education, selfmanagement, collaborative goal setting, and treatment planning. Patient-Centered Care (PCC) has been implemented for acute ambulatory settings. However, chronic disease management and prevention presents some unique challenges for PCC since the patient is followed by episodic office visits with often long and variable times between visits. For chronic disease care, innovative strategies are needed to support the constructs of PCC in an efficient and cost-effective manner. We believe that telemedicine, by empowering the patient and strengthening the patient-provider relationship, can support a chronic care model of PCC in a realistic and sustainable manner. Through previous grant funding, we have established a Telemedicine System for chronic disease management. Based on a personal health record, we have successfully used this system in diverse populations, in over 600 patients, and in multiple disease states (heart failure, CVD risk reduction, gestational diabetes). In this proposal, we will enhance this Telemedicine system to support PCC by increasing access, incorporating hypertension treatment guideline, quality measures, automating reminders and feedback for both patients and health care providers, and the ability of our personal health record (PHR) to exchange data between other HL7-compliant electronic medical record systems. Inner-city, primarily African-American patients (N=170) with uncontrolled hypertension (BP<140/90 mmHg) and who are followed by primary care physicians will be randomized to either a usual care or a telemedicine group (Telemedicine plus usual care). Blood pressure, weight, BMI, blood glucose and lipids, and physical activity will be measured at baseline and at 6 months. We hypothesize that more subjects in the telemedicine group will achieve goal blood pressure than in the control group. This will occur through increases in knowledge, self-management, shared decision-making, and improved doctor-patient interaction. Primary endpoint will be the proportion of subjects who achieve goal blood pressure. Secondary end-points will include: rate of self-monitoring, steps per day, weight, CVD knowledge, number of patients at medication guidelines, and increased satisfaction with practice. Telemedicine utilization will also be determined. We believe that telemedicine can facilitate PCC and reduce blood pressure in a cost effective manner.

描述（由申请人提供）：高血压影响美国6500万人，非裔美国人受到不成比例的影响。未经治疗的高血压与心肌违规，猝死，中风和肾衰竭的风险增加有关。尽管重要的是控制高血压和可用治疗，但公认的准则的临床应用令人失望。血压控制不足仍然太普遍了。为了改善对高血压等慢性病的护理，患者提供者的关系需要成熟成为伙伴关系。必须通过教育，自我管理，协作目标设定和治疗计划来提高患者赋权。以患者为中心的护理（PCC）已针对急性门诊环境实施。但是，慢性疾病管理和预防对PCC提出了一些独特的挑战，因为该患者随后进行了偶发性的办公访问，访问之间通常很长且可变的时间。对于慢性病护理，需要创新的策略来以有效且具有成本效益的方式支持PCC的构建体。我们认为，通过赋予患者能力并加强患者的关系，远程医疗可以以现实和可持续的方式支持PCC的慢性护理模型。 通过以前的赠款资金，我们建立了一种用于慢性病管理的远程医疗系统。根据个人健康记录，我们在不同人群，600多名患者和多种疾病状态（心力衰竭，CVD降低风险，妊娠糖尿病）中成功使用了该系统。在该提案中，我们将通过增加访问，包括患者和医疗保健提供者的高血压治疗指南，质量指南，自动提醒和反馈来增强该远程医疗系统，以支持PCC，以及我们个人健康记录（PHR）的能力（PHR）以在其他HL7符合的HL7齐全的电子记录系统之间交换数据。 内城，主要是非裔美国人患者（n = 170），患有不受控制的高血压（BP <140/90 mmHg），其后是初级保健医生，将随机分配给常规护理或远程医疗组（远程医疗以及通常的护理）。血压，体重，BMI，血糖和脂质以及体育活动将在基线和6个月时测量。我们假设，远程医疗组中的更多受试者将达到目标血压，而对照组中的血压将达到目标血压。这将通过增加知识，自我管理，共同决策和改善医生互动而发生。主要终点将是实现目标血压的受试者的比例。次要终点将包括：自我监控，每天的步骤，体重，CVD知识，药物指南中的患者数量以及对实践的满意度提高。还将确定远程医疗利用率。我们认为，远程医疗可以以成本效益的方式促进PCC并降低血压。