Finkelstein Joseph, Cha Eunme
Division of General Internal Medicine, Johns Hopkins University, Baltimore, MD 21205, USA.
Circ Cardiovasc Qual Outcomes. 2009 May;2(3):272-8. doi: 10.1161/CIRCOUTCOMES.109.849968.
We propose evaluation of a multi-component home automated telemanagement system providing integrated support to both clinicians and patients in implementing hypertension treatment guidelines. In a randomized clinical study, 550 blacks with hypertension are followed for 18 months. The major components of the intervention and control groups are identical and are based on the current standard of care. For the purpose of this study, we define "standard of care" as the expected evidence-based care provided according to the current hypertension treatment guidelines. Although intervention and control groups are similar in terms of their care components, they differ in the mode of care delivery. For the control group the best attempt is made to deliver all components of a guideline-concordant care in a routine clinical environment whereas for the intervention group the routine clinical environment is enhanced with health information technology that assists clinicians and patients in working together in implementing treatment guidelines. The home automated telemanagement system guides patients in following their individualized treatment plans and helps care coordination team in monitoring the patient progress. The study design is aimed at addressing the main question of this trial: whether the addition of the information technology-enhanced care coordination in the routine primary care setting can improve delivery of evidence-based hypertension care in blacks. The outcome parameters include quality of life, medical care use, treatment compliance, psychosocial variables, and improvement in blood pressure control rates. The trial will provide insight on the potential impact of information technology-enhanced care coordination in blacks with poorly controlled hypertension.
我们提议对一种多组件家庭自动化远程管理系统进行评估，该系统可为临床医生和患者在实施高血压治疗指南方面提供综合支持。在一项随机临床研究中，550名患有高血压的黑人被随访18个月。干预组和对照组的主要组成部分相同，均基于当前的护理标准。在本研究中，我们将“护理标准”定义为根据当前高血压治疗指南提供的基于证据的预期护理。尽管干预组和对照组在护理组成部分方面相似，但在护理提供方式上有所不同。对于对照组，尽力在常规临床环境中提供符合指南的护理的所有组成部分，而对于干预组，常规临床环境通过健康信息技术得到增强，该技术可协助临床医生和患者共同实施治疗指南。家庭自动化远程管理系统指导患者遵循其个性化治疗计划，并帮助护理协调团队监测患者进展。该研究设计旨在解决本试验的主要问题：在常规初级保健环境中增加信息技术增强的护理协调是否可以改善黑人患者基于证据的高血压护理的提供。结果参数包括生活质量、医疗服务使用情况、治疗依从性、心理社会变量以及血压控制率的改善情况。该试验将提供有关信息技术增强的护理协调对血压控制不佳的黑人患者潜在影响的见解。
