Lewinski Allison A, Bosworth Hayden B, Goldstein Karen M, Gierisch Jennifer M, Jazowski Shelley, McCant Felicia, White-Clark Courtney, Smith Valerie A, Zullig Leah L
Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA.
Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.
Contemp Clin Trials Commun. 2021 Feb 6;21:100705. doi: 10.1016/j.conctc.2021.100705. eCollection 2021 Mar.
Uncontrolled blood pressure (BP) is common among Veterans. Rural Veterans are at risk for suboptimal care coordination as successful programs may be implemented at lower rates due to individual- and system-level factors. There is strong evidence to support the use of remotely delivered support and patient-generated data from home BP monitors and virtual BP visits to manage BP.
The purpose of this project is to augment the current approach to addressing uncontrolled BP so that existing clinical staff can reach a larger patient population.
Our project will address uncontrolled BP by leveraging team-based care, the Veteran's Health Administration Electronic Health Record, and patient-centered medical home data to address patient, provider, and system barriers to cardiovascular disease (CVD) preventive care. We will implement this project in cardiovascular disease practices in three rural Veterans Health Administration clinics. We will evaluate implementation processes as well as patient-level (e.g., clinical outcomes, referrals to specialty services) outcomes in a one-arm, pre-post design.
This manuscript describes our process in expanding the implementation of a successful project to improve BP control in high-risk, rural Veterans. Findings from our study will inform an understanding of both implementation and clinical effectiveness outcomes of a potentially scalable BP intervention in rural, community-based clinics. Appropriate management of Veterans with uncontrolled BP can reduce morbidity and mortality related to CVD. In turn, improvements in BP, can lead to improved quality metrics and potentially decrease costs for a healthcare system.
血压不受控制在退伍军人中很常见。农村退伍军人面临护理协调欠佳的风险，因为由于个人和系统层面的因素，成功的项目实施率可能较低。有强有力的证据支持使用远程提供的支持以及来自家庭血压监测仪和虚拟血压就诊的患者生成数据来管理血压。
本项目的目的是改进当前解决血压不受控制问题的方法，以便现有临床工作人员能够覆盖更多患者群体。
我们的项目将通过利用团队式护理、退伍军人健康管理局电子健康记录以及以患者为中心的医疗之家数据来解决心血管疾病（CVD）预防护理中的患者、提供者和系统障碍，从而解决血压不受控制的问题。我们将在三个农村退伍军人健康管理局诊所的心血管疾病诊疗科室实施本项目。我们将采用单组前后设计评估实施过程以及患者层面的结果（如临床结局、专科服务转诊情况）。
本手稿描述了我们将一个成功项目的实施范围扩大以改善高危农村退伍军人血压控制的过程。我们研究的结果将有助于了解在农村社区诊所进行的一种潜在可扩展的血压干预措施的实施情况和临床有效性结果。对血压不受控制的退伍军人进行适当管理可以降低与心血管疾病相关的发病率和死亡率。反过来，血压的改善可以提高质量指标，并可能降低医疗系统的成本。
