Remote Monitoring and Virtual Collaborative Care for Hypertension Control to Prevent Cognitive Decline

远程监控和虚拟协作护理控制高血压以防止认知能力下降

基本信息

批准号：
10693852
负责人：
JEFFREY Murray BURNS
金额：
$ 289.44万
依托单位：
UNIVERSITY OF KANSAS MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-08-01 至 2025-07-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10693852
关键词：
Adherence Administrator Adopted Adoption Adverse effects Agreement Algorithms Alzheimer&apos s disease related dementia American American Heart Association Antihypertensive Agents Atherosclerosis Blood Pressure Blood Pressure Monitors Cardiology Cardiovascular system Caring Clinic Clinic Visits Clinical Pharmacists Clinical Trials Cognition Collaborations Communication Dementia Dose Education Elderly Electronic Health Record Eligibility Determination Enrollment Ensure Event Foundations Frequencies Future Goals Guidelines Health system Healthcare High Prevalence Home Home Blood Pressure Monitoring Hypertension Impaired cognition Incentives Incidence Institution Institutional Review Boards Intention Intervention Kansas Knowledge Manuals Measures Modeling Outcome Patients Pharmacists Pharmacy facility Phase Positioning Attribute Prevalence Prevention Primary Care Procedures Process Public Health Randomized Recommendation Recording of previous events Reproducibility Resources Risk Safety Sample Size Secure Site Structure System Testing Time Transportation Universities Utah age related blood pressure control blood pressure reduction cardiovascular disorder risk cardiovascular risk factor clinical care cohort collaborative care college cost dashboard dementia risk design effectiveness evaluation effectiveness trial effectiveness/implementation study health care service utilization human old age (65+)hypertension control implementation outcomes implementation science implementation study improved mild cognitive impairment mobile application mortality multidisciplinary new technology older patient operation participant enrollment phase 2 testing pragmatic implementation pragmatic trial prevent primary care clinic primary outcome programs public health relevance recruit remote monitoring satisfaction secondary outcome shared decision making treatment as usual virtual virtual delivery

项目摘要

Aggressive management of hypertension (HTN) may reduce the incidence of cognitive impairment, dementia, and Alzheimer’s disease and related dementias (ADRD). Despite this, 3 out of 4 older adults with HTN fail to reach blood pressure (BP) goals. Multiple barriers conspire against the efforts of patients and their clinicians to optimize BP in older patients. We believe these barriers are largely surmountable by reorganization of the current model of HTN management and leveraging new technology, implementation science, and team-based system-wide processes. Given the high prevalence of HTN, these health system-wide efforts may have a large impact on the prevalence of ADRD. As a potential public health approach to ADRD prevention, we propose a pragmatic-implementation study testing a health-system wide strategy leveraging home BP monitoring and a “virtual” Collaborative Care Clinic (vCCC) deployed in two health systems. We hypothesize this approach will safely and effectively lower BP and slow age-related decline in cognition while reducing cardiovascular risk, mortality, and health care utilization. The study will be structured in two phases. The primary objective of Phase I (R61) is to demonstrate feasibility, assess patient acceptability and satisfaction, and refine processes and procedures to enable high scale delivery of the vCCC at the health system level. We will obtain IRB approval, engage key stakeholders (health system, PCP’s and patients), optimize electronic health record (EHR) processes (alerts and referrals), refine care algorithms and processes, and launch the intervention in 3 primary care clinics. We will enroll n= 60 patients to vCCC for 3 months to assess important implementation outcomes and inform go / no-go decisions. Upon achieving the milestones of Phase I, we will scale the program to meet the Phase II (R31) objective of implementing the intervention across two different health systems (Universities of Kansas and Utah Health Systems) to randomize n=1000 patients to vCCC vs. controls (usual care with education) for 2 years. We will assess effectiveness of vCCC in achieving BP goals (1º) and reducing 2º measures of cognitive decline, major adverse cardiovascular events, atherosclerotic cardiovascular disease risk, health care resource utilization, and mortality. We will also assess critical implementation outcomes relevant to wide-scale adoption including feasibility, acceptability, appropriateness, and intention to adopt. Our multidisciplinary collaborative team and history of collaboration with our health system provides an excellent foundation for this study. We have the necessary expertise in clinical trials for ADRD prevention, HTN management, and EHR focused pragmatic trials at both institutions. With the successful implementation of our BP lowering program across the two health systems, we will be well-positioned to scale the model to multiple health systems for definitive testing on reducing the incidence of ADRD in a much larger cohort.

积极治疗高血压 (HTN) 可能会降低认知障碍、痴呆和阿尔茨海默病及相关痴呆 (ADRD) 的发生率，尽管如此，四分之三的高血压老年人仍无法达到血压 (BP) 目标。我们相信，通过重组当前的 HTN 管理模式并利用新技术、实施科学和基于团队的全系统流程，这些障碍在很大程度上可以克服。鉴于 HTN 的高患病率，这些卫生系统范围内的努力可能会对 ADRD 的患病率产生重大影响，作为预防 ADRD 的潜在公共卫生方法，我们提出一项实用的实施研究，测试利用家庭的卫生系统范围策略。我们在两个卫生系统中部署了血压监测和“虚拟”协作护理诊所（vCCC），我们探索了这种方法将安全有效地降低血压并减缓与年龄相关的认知能力下降，同时降低心血管风险、死亡率和医疗保健利用率。第一阶段 (R61) 的主要目标是证明可行性、评估患者的可接受性和满意度，并完善流程和程序，以实现在卫生系统层面大规模交付 vCCC。批准，吸引主要利益相关者（卫生系统、PCP 和患者），优化电子健康记录 (EHR) 流程（警报和转诊），完善护理算法和流程，并在 3 个初级保健诊所启动干预措施，我们将招募 n= 60 家诊所。患者为期 3 个月的 vCCC 评估重要的实施结果并为实施/不实施决策提供信息在实现第一阶段的里程碑后，我们将扩大该计划以实现在两个不同卫生系统中实施干预措施的第二阶段 (R31) 目标。（堪萨斯大学和犹他州卫生系统大学）将 n=1000 名患者随机分为 vCCC 与对照（常规护理和教育），为期 2 年。我们将评估 vCCC 在实现血压目标 (1°) 和减少 2° 测量方面的有效性。我们还将评估与广泛采用相关的关键实施结果，包括可行性、可接受性、适当性和采用意图。我们的团队以及与我们卫生系统的合作历史为这项研究奠定了良好的基础，我们在两个机构的 ADRD 预防、高血压管理和以 EHR 为重点的实用试验方面拥有必要的专业知识。跨越两个健康系统，我们将处于有利地位，将该模型扩展到多个卫生系统，以在更大的队列中进行确定性测试，以降低 ADRD 的发病率。