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
基本信息
- 批准号:10198144
- 负责人:
- 金额:$ 69.46万
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 财政年份:2021
- 资助国家:美国
- 起止时间:2021-08-15 至 2022-07-31
- 项目状态:已结题
- 来源:
- 关键词:AbbreviationsAddressAdoptedAdoptionAdvisory CommitteesAfrican AmericanAmbulatory Blood Pressure MonitoringAttitudeCardiovascular DiseasesCaringClinicalCluster randomized trialCodeCost AnalysisDataDiagnosisEffectivenessElementsEvaluationEvidence based practiceGlossaryGoalsHome Blood Pressure MonitoringHybridsHypertensionInfrastructureKnowledgeLeadershipLearningLengthLow incomeMaintenanceManualsMeasuresMedicalMethodsMinorityModelingMotivationOffice VisitsOutcomePatient EducationPatientsPerformancePersonal GrowthPhasePractical, Robust Implementation and Sustainability ModelPrimary Health CareProblem SolvingProceduresProcessProgress ReportsPublishingQuality of lifeReach, Effectiveness, Adoption, Implementation, and MaintenanceReadinessReadingReportingResearch PersonnelResourcesRisk FactorsRoleScienceSiteTestingTimeTimeLineTrainingUnited StatesWorkbasecardiovascular disorder preventionfollow-upformative assessmenthypertension controlimplementation costimplementation processimplementation strategyimprovedimproved functioningmeetingsmodifiable riskpatient orientedprimary outcomeracial disparityrecruitsecondary outcomeskills
项目摘要
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的最重要的,医学上可修改的风险因素
美国疾病。控制高血压对于改善生活的长度和质量至关重要
美国以及解决心血管疾病中的种族差异。然而,国家的进步
控制高血压已经停滞了。美国当前的高血压护理模型
事实证明,几乎完全在临床医生驱动的办公室访问中。迫切需要团队 -
基于以患者为中心的护理模型。基于团队的家庭血压监测(TB-HBPM)
代表一种基于证据的实践,在初级保健中被广泛使用。需要策略
促进其在初级保健中的收养。基于已发表的TB-HBPM采用障碍,成功
策略必须让患者和临床医生参与实施过程,并为患者及其提供
具有实施和维持TB-HBPM所需的知识,技能,资源和数据的护理团队。
值得注意的是,策略必须解决财务可持续性。该提议的主要目标是确定
并严格评估在内部实施和维持TB-HBPM的可翻译策略
初级保健。为了实现这一目标,我们将从一个高血压的单个站点招募七种实践
控制是次优的。这些做法主要为低收入和少数族裔患者提供服务。在阶段1(R61)中,
我们将召集一个指导委员会,其中包括患者,执业人员和临床医生,以指导计划,
实施,可持续性和评估(目标1)。在第1阶段,我们将评估特定的障碍和
在这些实践中实施TB-HPBM的促进者。基于这些特定实践的障碍,我们将
使用实用,健壮,实施和可持续性模型(PRISM)运营策略。在
第2阶段(R33),我们将使用混合类型2,步进楔形集群部署这些实现策略
随机试验(AIM 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)框架的策略(AIM 3)。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
不受控制的BP患者在60天内看到,团队建立团队宪章
(采用)和基于成本分析(维护)的财务可持续性。我们将使用现实主义者评估
测试实施策略基础的理论假设(AIM 4)。这种混合方法
方法将使我们能够为其他设置开发可转移的课程。我们的发现将推进科学
实施成功的HTN管理模型,并为更广泛的路线图提供了路线图
在初级保健中实施TB-HBPM。
项目成果
期刊论文数量(0)
专著数量(0)
科研奖励数量(0)
会议论文数量(0)
专利数量(0)
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{{ truncateString('Kevin Fiscella', 18)}}的其他基金
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:
10701721 - 财政年份:2022
- 资助金额:
$ 69.46万 - 项目类别:
Identifying Successful Strategies for Implementing Team-Based Home Blood Pressure Monitoring in Primary Care
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