Promoting Self-Management in Stroke Survivors Using Health IT

利用健康信息技术促进中风幸存者的自我管理

• 批准号: 8429801
• 负责人: KAMAKSHI LAKSHMINARAYAN
• 金额: $ 15.73万
• 依托单位: UNIVERSITY OF MINNESOTA
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-30 至 2014-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8429801
• 关键词: Promoting; Self; Management; Stroke; Survivors

DESCRIPTION (provided by applicant): The long-term research goal is to develop care management interventions to prevent hospital readmissions in stroke survivors and thereby improve stroke survival, reduce cumulative disability due to recurrent vascular events and prevent post-stroke complications. Stroke survivors have a greater prevalence of vascular risk factors, namely, hypertension (HTN), diabetes mellitus and elevated cholesterol, compared to the general population. Consequently, they are at a very high risk of post-stroke hospital readmissions for vascular events such as recurrent stroke, heart attacks and heart failure. There is sub-optimal management of vascular risk factors in the outpatient setting and medication non-compliance by stroke survivors. Two-thirds of stroke survivors have residual disabilities and are frequently dependent on caregivers for transportation to clinic visits. Post- discharge stroke care in the community is fragmented, inconsistent and has been characterized as a neglected battle. Interventions to improve medication compliance and reduce caregiver burden can prevent hospital readmissions, improve outcomes and ultimately decrease societal costs of medical care for stroke survivors. Currently, there are 7 million stroke survivors in the United States. We propose a proof-of-concept study to demonstrate the use of an online health management tool for self management tasks and Medication Therapy Management (MTM) in stroke survivors, using HTN control as an illustrative example. A 2-group, parallel randomized control trial design will be used with the intervention group assigned to the online health management tool and the control group assigned to usual care. Study aims will i) Assess usability of the online health management tool by stroke survivors and their caregivers; ii) Examine rates of HTN control in the intervention vs. control groups at 3 months after enrollment. iii) Examine rates of adherence to antihypertensive medications at 3 months after enrollment in the intervention versus control groups. System usability will be assessed with the AHRQ recognized System Usability Scale. While this study illustrates our conceptual framework using the example of HTN control, we envision a comprehensive health IT based system for post-stroke care addressing multiple aspects including medication management, rehabilitative therapy and lifestyle modification (diet, exercise) in this high risk population. This study will provide preliminary data for a larger trialand will evaluate the usability of online health management tools among stroke survivors, (a patient group with cognitive, motor and functional limitations) and, identify barriers to their adoption. PUBLIC HEALTH RELEVANCE: This study proposes to achieve "better health and better care at lower cost" by using an online health management tool to improve medication management in stroke survivors, thereby preventing recurrent vascular events and hospital readmissions.

描述（由申请人提供）：长期的研究目标是制定护理管理干预措施，以防止中风幸存者的医院再入院，从而改善中风的存活，从而减少由于复发性血管事件而导致的累积残疾，并防止中风后并发症。与普通人群相比，中风幸存者的血管危险因素的患病率更高，即高血压（HTN），糖尿病和胆固醇升高。因此，他们对诸如复发性中风，心脏病发作和心力衰竭等血管事件的冲程后医院再入院的风险很高。在门诊环境和中风幸存者不合规的药物中，血管危险因素具有次优的管理。三分之二的中风幸存者有残疾残疾，并且经常取决于护理人员运输到临床就诊。出院后卒中护理 在社区中，社区分散，不一致，被描述为一场被忽视的战斗。改善药物合规性和减轻护理人员负担的干预措施可以防止医院再入院，改善结果并最终降低中风幸存者的医疗服务的社会成本。目前，美国有700万中风幸存者。我们提出了一项概念验证研究，以证明使用HTN Control作为一个说明性的例子，在中风幸存者中使用了在线健康管理工具进行自我管理任务和药物治疗管理（MTM）。将分配给在线健康管理工具的干预组和分配给常规护理的对照组的两组平行的随机控制试验设计将使用。研究目标i）评估中风幸存者及其护理人员的在线健康管理工具的可用性； ii）在入学后3个月内检查干预组与对照组中HTN控制的速率。 iii）检查干预组与对照组3个月后3个月内遵守降压药的率。系统可用性将通过AHRQ认可的系统可用性量表进行评估。虽然这项研究以HTN控制的示例说明了我们的概念框架，但我们设想了一种基于综合的健康IT系统，用于触摸后护理，以解决该高风险人群中的多个方面，包括药物管理，康复治疗和生活方式修改（饮食，锻炼）。这项研究将为大型试验提供初步数据，并将评估中风幸存者（具有认知，运动和功能限制的患者群体）中在线健康管理工具的可用性，并确定其采用障碍。 公共卫生相关性：本研究建议通过使用在线健康管理工具改善中风幸存者的药物管理，从而实现“更好的健康和更好的护理”，从而防止复发性的血管事件和医院再入院。