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: 7682813
• 负责人: Alfred Anthony Bove
• 金额: $ 37.79万
• 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 2011-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7682813
• 关键词: Using; Telemedicine; System; Promote; Patient

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, self- management, 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 end- point 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. Hypertension (high blood pressure) 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. This study will test the effectiveness of an Internet based telemedicine system to strengthen the patient-provider relationship and to educate and empower individuals with hypertension to take a more active role in their own health care.

高血压影响美国超过6500万人，非裔美国人不成比例地影响 做作的。未经治疗的高血压与心肌违规，猝死， 中风和肾衰竭。尽管重要的是控制高血压和可用疗法，但临床 完善的准则的应用令人失望。血压控制不足 一切都太普遍了。为了改善慢性疾病（例如高血压）的护理，患者培训关系 需要成熟成一个伙伴关系。必须通过教育，自我来提高患者的赋权 管理，协作目标设定和治疗计划。以患者为中心的护理（PCC） 用于急性门诊环境。但是，慢性疾病管理和预防呈现 PCC面临一些独特的挑战，因为患者之后是经常长时间的情节访问 访问之间的可变时间。对于慢性病护理，需要创新策略来支持 PCC的构造以有效且具有成本效益的方式。我们认为，远程医疗是通过增强 患者并加强患者提供者的关系，可以支持PCC的慢性护理模型 现实和可持续的方式。 通过以前的赠款资金，我们建立了一种用于慢性病的远程医疗系统 管理。根据个人健康记录，我们成功地将该系统用于多样化 种群在600多名患者和多种疾病状态（心力衰竭，CVD降低，妊娠中 糖尿病）。在此建议中，我们将增强该远程医疗系统，以通过增加访问访问范围来支持PCC 合并高血压治疗指南，质量措施，自动提醒和反馈 患者和医疗保健提供者，以及我们的个人健康记录（PHR）交换数据的能力 在其他符合HL7的电子病历系统之间。 市中心，主要是非裔美国人患者（n = 170），具有不受控制的高血压（BP <140/90 mmHg） 然后是初级保健医生，将随机分配给通常的护理或远程医疗 小组（远程医疗和常规护理）。血压，体重，BMI，血糖和脂质以及物理 活动将在基线和6个月时测量。我们假设远程医疗中的更多主题 小组将达到目标血压，而不是对照组。这将通过增加 知识，自我管理，共享决策和改善医生互动。初端 - 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，药物指南的患者数量， 并提高对实践的满意。还将确定远程医疗利用率。我们相信 远程医疗可以以成本效益的方式促进PCC并降低血压。高血压（高血压）与非裔美国人在美国影响超过6500万人 受到不成比例的影响。未经治疗的高血压与心肌风险增加有关 违规，猝死，中风和肾衰竭。这项研究将测试基于互联网的有效性 远程医疗系统以加强患者提供者的关系并教育和授权个人 高血压在自己的医疗保健中发挥更积极的作用。