Maryland Telehome Care Network (MTCN)

马里兰州远程家庭护理网络 (MTCN)

• 批准号: 7855562
• 负责人: CLAUDIA R0SE BAQUET
• 金额: $ 136.42万
• 依托单位: UNIVERSITY OF MARYLAND BALTIMORE
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-28 至 2011-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7855562
• 关键词: Accident and Emergency department; Address; American; Americas; Area; Area Health Education Centers; Attention; Biological Preservation; Caring; Chronic; Chronic Disease; Chronic Obstructive Airway Disease; Clinical; Clinical Management; Communities; Community Health; County; Diabetes Mellitus; Disease; Disease Management; Economics; Environment; Equation; Evaluation; Funding; Genetic Crossing Over; Geography; Goals; Grant; Guidelines; Health; Health Professional; Health Services Accessibility; Health Status; Health Technology; Health care facility; Health education; Healthcare; Heart failure; Home Care Services; Home Health Agency; Hospitalization; Hypertension; Improve Access; Individual; Investments; Low income; Maryland; Measures; Medical; Metabolic syndrome; Minority; Modality; Monitor; National Center on Minority Health and Health Disparities; Occupations; Outcome; Patients; Pharmaceutical Preparations; Physiological; Poverty; Process; Professional Education; Provider; Quality of life; Recommendation; Recording of previous events; Recovery; Research; Research Infrastructure; Resources; Risk; Rural; Rural Community; Rural Health; Rural Population; Self-control as a personality trait; Services; Social Environment; Societal Factors; Solutions; Structure; Targeted Research; Technology; Telephone Monitor for the Elderly; Time; Translational Research; Transportation; United States National Institutes of Health; Universities; Visit; World Health Organization; base; cohort; cost; design; efficacy testing; evidence base; health care delivery; health disparity; improved; infancy; innovation; insight; medical schools; medical specialties; medically underserved; new technology; population based; programs; prospective; rural area; satisfaction; social; social health determinants; theories

DESCRIPTION (provided by applicant): This application addresses the National Center on Minority Health and Health Disparities' (NCMHD's) Social Determinants of Health Initiative high priority area for funding under the NIH Research and Research Infrastructure Grand Opportunity. The project is a collaborative effort between the University of Maryland School of Medicine (UMSOM), its established educational partners-Eastern Shore Area Health Education Center (ESAHEC) located in rural Eastern Shore Maryland and the Western Maryland Area Health Education Center (WMAHEC) located in rural Western Maryland, and its rural health care delivery partners- Garrett County Health Department Home Health Agency (GCHDHHA, in rural Western Maryland) and the Chesapeake Potomac Home Health Agency (CPHHA, in rural Southern Maryland). The broad goals of the project are to reduce disparities, within the broad context of social determinants of health, in chronic disease management among minority, low-income white, and medically underserved patients residing in rural geographies by building an innovative telehome care (THC) capacity and generating theoretically-based, scientifically rigorous and high quality evidence on the ability of the technology to enhance access to specialty care, improve clinical outcomes, and positively impact medical resource utilization in rural and medically underserved communities. With these broad goals, the project aims to refocus attention and resources towards high value translational research approaches that help transform health care practices using novel technologies. The specific aims are: (1) To use a cross-over, prospective cohort design to test the efficacy of a structured 90 day time-limited THC program to enhance access to evidence based best practices in the clinical management of Metabolic Syndrome/Diabetes Mellitus (DM), Chronic Heart Failure (CHF), Hypertension (HTN), and Chronic Obstructive Pulmonary Disease (COPD); (2) To evaluate the impact of this 90 day time-limited THC program on medical resource utilization and effects on Quality of Life; and, (3) To evaluate a patient and health care professional education program on THC to enhance acceptability and satisfaction. The project, guided by the socioecological theory of health and the community based participatory framework, will be implemented in rural Western and Southern Maryland counties among 250 eligible patients receiving home health care through GCHDHHA and CPHHA. Informed by the social determinants of health and the socioecological theory of health, the project's measures examine, besides individual-level factors, social/ interpersonal, community/institutional, and societal factors and their relationships to chronic diseases and its management. The patients will be assessed at baseline, 30-days, and 90-days on medication history, number of emergency department visits and/or hospitalizations, and Quality of Life. The analytical strategy includes the use of summary measures, repeated measure ANOVA, and generalized estimating equations. The project also has a rigorous process evaluation component to monitor and triangulate delivery of the THC program. Benefits of the project include the preservation of 12 jobs and creation of 14 new jobs, the promotion of economic recovery among rural communities in Maryland, and insights into the applicability of e-health technologies in the cost-effective management of chronic diseases. With the focus on rural populations facing serious health disparities, evidence of improved access to care and clinical outcomes will prove to be an invaluable investment towards us achieving the national priority of elimination of health disparities within the multi-factorial social determinants of health perspective. The project will have an impact on our understanding of the ability of cost-efficient technologies to deliver high quality medical specialty care to rural settings, thus reducing chronic disease management disparities among the minorities, low-income white, and the medically underserved residing in rural settings.

描述（由申请人提供）：本申请涉及国家少数族裔健康和健康差异中心 (NCMD) 的健康社会决定因素倡议的高度优先领域，该领域是 NIH 研究和研究基础设施大机遇资助的重点领域。该项目是马里兰大学医学院 (UMSOM) 与其既定教育合作伙伴——位于马里兰州东海岸农村的东海岸地区健康教育中心 (ESAHEC) 和位于马里兰州西马里兰地区健康教育中心 (WMAHEC) 之间的合作成果。马里兰州西部农村地区及其农村医疗保健提供合作伙伴 - 加勒特县卫生局家庭健康机构 (GCHDHHA，马里兰州西部农村地区) 和切萨皮克波托马克家庭健康机构 (CPHHA，在马里兰州南部农村）。该项目的总体目标是通过建立创新的远程家庭护理 (THC)，在健康社会决定因素的广泛背景下，减少居住在农村地区的少数民族、低收入白人和医疗服务不足的患者在慢性病管理方面的差异能力，并生成基于理论、科学严谨和高质量的证据，证明该技术能够增强获得专业护理的机会，改善临床结果，并对农村和医疗服务不足的社区的医疗资源利用产生积极影响。凭借这些广泛的目标，该项目旨在将注意力和资源重新集中到高价值的转化研究方法上，这些方法有助于利用新技术改变医疗保健实践。具体目标是：(1) 使用交叉、前瞻性队列设计来测试结构化的 90 天限时 THC 计划的有效性，以增强代谢综合征/糖尿病临床管理中基于证据的最佳实践的获取(DM)、慢性心力衰竭 (CHF)、高血压 (HTN) 和慢性阻塞性肺疾病 (COPD)； (2) 评估本次90天限时THC计划对医疗资源利用的影响以及对生活质量的影响； (3) 评估有关 THC 的患者和医疗保健专业教育计划，以提高可接受性和满意度。该项目以健康社会生态学理论和基于社区的参与框架为指导，将在马里兰州西部和南部的农村县实施，让 250 名符合资格的患者通过 GCHDHHA 和 CPHHA 接受家庭保健。根据健康的社会决定因素和健康的社会生态学理论，该项目的措施除了个人层面的因素外，还研究社会/人际、社区/机构和社会因素及其与慢性病及其管理的关系。将在基线、30 天和 90 天时对患者的用药史、急诊科就诊和/或住院次数以及生活质量进行评估。分析策略包括使用汇总测量、重复测量方差分析和广义估计方程。该项目还具有严格的流程评估部分，用于监控和三角测量 THC 计划的交付。该项目的好处包括保留 12 个就业岗位和创造 14 个新就业岗位，促进马里兰州农村社区的经济复苏，以及深入了解电子医疗技术在慢性病成本效益管理中的适用性。随着对面临严重健康差距的农村人口的关注，改善获得护理和临床结果的证据将被证明是对我们实现从健康的多因素社会决定因素角度消除健康差距的国家优先事项的宝贵投资。该项目将影响我们对具有成本效益的技术向农村地区提供高质量医疗专业护理的能力的理解，从而减少少数民族、低收入白人和农村地区医疗服务不足的居民之间的慢性病管理差距设置。