Department of Medicine, Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States.
Center for Primary Care Innovation, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States.
Appl Clin Inform. 2023 May;14(3):428-438. doi: 10.1055/a-2057-7277. Epub 2023 Mar 18.
Out-of-office blood pressure (BP) measurements contribute valuable information for guiding clinical management of hypertension. Measurements from home devices can be directly transmitted to patients' electronic health record for use in remote monitoring programs.
This study aimed to compare in primary care practice care coordinator-assisted implementation of remote patient monitoring (RPM) for hypertension to RPM implementation alone and to usual care.
This was a pragmatic observational cohort study. Patients aged 65 to 85 years with Medicare insurance from two populations were included: those with uncontrolled hypertension and a general hypertension group seeing primary care physicians (PCPs) within one health system. Exposures were clinic-level availability of RPM plus care coordination, RPM alone, or usual care. At two clinics (13 PCPs), nurse care coordinators with PCP approval offered RPM to patients with uncontrolled office BP and assisted with initiation. At two clinics (39 PCPs), RPM was at PCPs' discretion. Twenty clinics continued usual care. Main measures were controlling high BP (<140/90 mm Hg), last office systolic blood pressure (SBP), and proportion with antihypertensive medication intensification.
Among the Medicare cohorts with uncontrolled hypertension, 16.7% (39/234) of patients from the care coordination clinics were prescribed RPM versus <1% (4/600) at noncare coordination sites. RPM-enrolled care coordination group patients had higher baseline SBP than the noncare coordination group (148.8 vs. 140.0 mm Hg). After 6 months, in the uncontrolled hypertension cohorts the prevalences of controlling high BP were 32.5% (RPM with care coordination), 30.7 % (RPM alone), and 27.1% (usual care); multivariable adjusted odds ratios (95% confidence interval) were 1.63 (1.12-2.39; = 0.011) and 1.29 (0.98-1.69; = 0.068) compared with usual care, respectively.
Care coordination facilitated RPM enrollment among poorly controlled hypertension patients and may improve hypertension control in primary care among Medicare patients.
在诊室外测量血压（BP）可以提供有价值的信息，有助于指导高血压的临床管理。家庭设备测量的血压值可以直接传输到患者的电子健康记录中，用于远程监测计划。
本研究旨在比较初级保健实践中由护理协调员辅助实施的远程患者监测（RPM）治疗高血压与 RPM 单独实施和常规护理的效果。
这是一项实用的观察性队列研究。研究对象来自两个群体的 65 岁至 85 岁的 Medicare 保险患者：血压控制不佳的患者和在一个医疗系统内看初级保健医生（PCP）的一般高血压患者。暴露因素为诊所层面 RPM 加护理协调的可用性、单独的 RPM 或常规护理。在两个诊所（13 名 PCP），经过 PCP 批准的护士护理协调员为血压控制不佳的门诊 BP 患者提供 RPM，并协助启动。在两个诊所（39 名 PCP），RPM 由 PCP 自行决定。20 个诊所继续进行常规护理。主要测量指标是控制高血压（<140/90mmHg）、最近的门诊收缩压（SBP）和抗高血压药物强化的比例。
在血压控制不佳的 Medicare 队列中，护理协调诊所的 16.7%（39/234）患者接受了 RPM 治疗，而非护理协调诊所的这一比例不到 1%（4/600）。接受 RPM 治疗的护理协调组患者的基线 SBP 高于非护理协调组（148.8 比 140.0mmHg）。在 6 个月后，血压控制不佳的队列中，控制高血压的患病率分别为 32.5%（RPM 加护理协调）、30.7%（单独 RPM）和 27.1%（常规护理）；多变量调整后的比值比（95%置信区间）分别为 1.63（1.12-2.39；P=0.011）和 1.29（0.98-1.69；P=0.068）与常规护理相比。
护理协调促进了血压控制不佳的高血压患者接受 RPM 治疗，并且可能改善 Medicare 患者的初级保健中高血压的控制。
