Targeting of UnControlled Hypertension in Emergency Department (TOUCHED)

以急诊科不受控制的高血压为目标（TOUCHED）

基本信息

批准号：
9581825
负责人：
HEATHER Marie PRENDERGAST
金额：
$ 50.53万
依托单位：
UNIVERSITY OF ILLINOIS AT CHICAGO
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-09-05 至 2019-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9581825
关键词：
Accident and Emergency department Acute Address Advanced Practice Nurse Affect African American Blood Pressure Blood Pressure Monitors Cardiovascular system Caring Consultations Coupled Critical Care Data Development Echocardiography Effectiveness Emergency Department patient Federally Qualified Health Center Health Health Sciences Healthcare Systems Heart Diseases Heart failure High Prevalence Hispanics Home Blood Pressure Monitoring Hospitals Hour Hypertension Illinois Individual Instruction Intervention Kidney Failure Knowledge Low income Measures Mediator of activation protein Minority Modeling Morbidity - disease rate Motivation Outpatients Participant Patient risk Patients Pharmacists Population Prevalence Prevention Primary Health Care Randomized Randomized Controlled Trials Risk Risk Assessment Risk Factors Secondary to Service delivery model Stratification Stroke System Underrepresented Groups Underrepresented Populations United States Universities arm base blood pressure regulation cardiovascular risk factor care delivery care systems demographics empowerment ethnic minority population follow-up health disparity high risk improved innovation mHealth medication compliance mortality novel patient population portability post intervention primary care setting primary outcome prospective racial and ethnic racial disparity racial minority secondary outcome treatment arm treatment as usual urban setting usual care arm

项目摘要

Changing care delivery models to address uncontrolled hypertension (HTN) while decreasing the secondary cardiovascular complications commonly seen in underrepresented populations that use the emergency department (ED) for primary care are critically needed. Uncontrolled hypertension (HTN) contributes significantly to cardiovascular morbidity and mortality and is more frequently encountered among patients presenting to the ED as compared to the primary care setting. EDs serve as the point of entry into the health care system for many high-risk patient populations, including minority and low-income patients. Based upon recent studies, the prevalence of uncontrolled/undiagnosed HTN in patients presenting to the ED is alarmingly high. Thus emergency department engagement and early risk assessment/stratification is a feasible innovation to help close health disparity gaps in HTN. This proposal involves a two-arm randomized controlled trial of 686 patients from the Emergency Department at University of Illinois Hospital with moderately elevated blood pressures (BP ≥ 140/90 mmHg). The primary outcome will be blood pressure improvement. Secondary outcomes will be blood pressure control, improvement of cardiovascular risk score, medication adherence, primary care engagement, patient motivation, and HTN knowledge. The central hypothesis of our proposal is that an ED-based educational and empowerment (E2) intervention coupled with an ED pharmacist/Advanced Practice Nurse (APN) Post-Acute Care Hypertension Transition Consultation (PACHT-c) and mobile health remote BP monitoring will educate and empower patients to improve their BPs and decrease their cardiovascular risk profile as measured by the Framingham Risk Score, and can be impactful in a predominately underrepresented hypertensive population.

改变护理交付模型以解决不受控制的高血压（HTN），同时减少次要在使用紧急情况的人群中通常看到的心血管并发症至关重要的是初级保健部门（ED）。不受控制的高血压（HTN）显着贡献出现在心血管的发病率和死亡率，并且在出现的患者中更频繁地遇到与初级保健环境相比。 EDS是许多人进入医疗保健系统的点高风险的患者人群，包括少数族裔和低收入患者。基于最近的研究出现在ED的患者中，未受控制/未诊断的HTN的患病率令人震惊。那急诊部门的参与和早期风险评估/分层是可行的创新，可帮助关闭 HTN的健康差异差距。该提案涉及一项两臂随机对照试验，对来自急诊科的686名患者伊利诺伊大学医院的血压升高（BP≥140/90mmHg）。主要结果将是改善血压。次要结果将是血压控制，改善心血管风险评分，药物依从性，初级保健参与，患者动机和HTN 知识。我们建议的核心假设是基于ED的教育和授权（E2）干预措施与ED药剂师/高级实践护士（APN）急性护理高血压过渡咨询（PACHT-C）和移动卫生远程BP监控将教育和授权患者为了改善BP并减少弗雷明汉风险评分衡量的心血管风险概况，并且在主要代表性不足的高血压人群中可能会产生影响。