项目 ACTIVE：在城市保障体系中实施以患者为中心的个性化预防保健的随机对照试验。

Project ACTIVE: a Randomized Controlled Trial of Personalized and Patient-Centered Preventive Care in an Urban Safety-Net Setting.

机构信息

New York University Langone Health, 462 1st Avenue, Desk 2D, New York, NY, 10016, USA.

MDRC, New York, NY, USA.

出版信息

J Gen Intern Med. 2021 Mar;36(3):606-613. doi: 10.1007/s11606-020-06359-z. Epub 2021 Jan 14.

DOI:10.1007/s11606-020-06359-z

PMID:33443695

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7947038/

Abstract

BACKGROUND

Evidence-based preventive care in the USA is underutilized, diminishing population health and worsening health disparities. We developed Project ACTIVE, a program to improve adherence with preventive care goals through personalized and patient-centered care.

OBJECTIVE

To determine whether Project ACTIVE improved utilization of preventive care and/or estimated life expectancy compared to usual care.

DESIGN

Single-site randomized controlled trial.

PARTICIPANTS

Cluster-randomized 140 English or Spanish speaking adult patients in primary care with at least one of twelve unfulfilled preventive care goals based on USPSTF grade A and B recommendations.

INTERVENTION

Project ACTIVE employs a validated mathematical model to predict and rank individualized estimates of health benefit that would arise from improved adherence to different preventive care guidelines. Clinical staff engaged the participant in a shared medical decision-making (SMD) process to identify highest priority unfulfilled clinical goals, and health coaching staff engaged the participant to develop and monitor action steps to reach those goals.

MAIN MEASURES

Change in number of unfulfilled preventive care goals from USPSTF grade A and B recommendations and change in overall gain in estimated life expectancy.

KEY RESULTS

In an intent-to-treat analysis, Project ACTIVE increased the average number of fulfilled preventive care goals out of 12 by 0.68 in the intervention arm compared with 0.15 in the control arm (mean difference [95% CI] 0.53 [0.19-0.86]), yielding a gain in estimated life expectancy of 8.8 months (3.8, 14.2). In a per-protocol analysis, Project ACTIVE increased fulfilled preventive care goals by 0.80 in the intervention arm compared with 0.16 in the control arm (mean difference [95% CI], 0.65 [0.25-1.04]), yielding a gain in estimated life expectancy of 13.7 months (6.2, 21.2). Among the 12 preventive care goals, more improvement occurred for alcohol use, hypertension, hyperlipidemia, depression, and smoking.

CONCLUSIONS

Project ACTIVE improved unfulfilled preventive care goals and improved estimated life expectancy.

CLINICAL TRIAL REGISTRATION NUMBER

NCT04211883.

摘要

背景

美国的循证预防保健服务未得到充分利用，这降低了人群的健康水平，并加剧了健康差距。我们开发了 Project ACTIVE 项目，旨在通过个性化和以患者为中心的护理来提高对预防保健目标的依从性。

目的

确定 Project ACTIVE 是否比常规护理更能提高预防保健的利用率和/或估计的预期寿命。

设计

单站点随机对照试验。

参与者

根据 USPSTF 分级 A 和 B 建议，将 140 名至少有 12 项未完成的预防保健目标的英语或西班牙语成年初级保健患者进行聚类随机分组，这些目标未得到满足。

干预

Project ACTIVE 采用经过验证的数学模型，预测和对改善对不同预防保健指南的依从性而产生的个人健康获益进行排序。临床工作人员通过共享医疗决策（SMD）流程使患者参与其中，以确定未满足的最高优先级临床目标，健康教练工作人员使患者参与其中，以制定和监测实现这些目标的行动步骤。

主要措施

从 USPSTF 分级 A 和 B 建议中未满足的预防保健目标数量的变化以及总体估计预期寿命的增加。

主要结果

在意向治疗分析中，与对照组相比，干预组的 12 项预防保健目标中，实际完成的目标数量平均增加了 0.68 项，而对照组为 0.15 项（平均差异 [95%CI] 0.53 [0.19-0.86]），这使得预期寿命增加了 8.8 个月（3.8，14.2）。在按方案分析中，与对照组相比，干预组完成的预防保健目标增加了 0.80 项，对照组为 0.16 项（平均差异 [95%CI]，0.65 [0.25-1.04]），这使得预期寿命增加了 13.7 个月（6.2，21.2）。在 12 项预防保健目标中，酒精使用、高血压、高血脂、抑郁和吸烟的改善更为明显。