Many people get stressed when they visit the doctor, leading to blood pressure readings higher than normal. It's called "White Coat Syndrome." And since two-thirds of diabetics suffer from high blood pressure, getting accurate readings is crucial to getting proper care for them. Jenna L. Marquard of the University of Massachusetts Amherst is part of a team of researchers involved in a $2-million project to develop low-cost technology that will allow diabetics to test their blood pressure at home and send those readings automatically to nurses so their medication can be adjusted as frequently as needed.
It's easy and not stressful. "They just have to plug it in," says Marquard about using a simple blood pressure monitoring instrument for reporting the readings.
The $1.9 million project is being carried out by the UMass Medical School, the UMass Amherst College of Engineering and Fallon Clinics in Central Massachusetts - a large multi-specialty medical group practice with more than 250 doctors providing healthcare services in more than 20 medical facilities. It is supported by the Agency for Healthcare Research and Quality, a federal organization affiliated with the National Institutes of Health. The principal investigator is Dr. Barry Saver of the UMass Medical School, and the UMass Amherst engineering portion is $342,228.
The system being tested teaches people with diabetes how to use a blood-pressure measuring device at home. The device is plugged into a computer and feeds the readings automatically into the patient's centralized electronic health record, and from there is sent directly to the patient's nurses.
"My main component in the study is to understand how people use this technology and how it supports the goals of this whole preventative healthcare process," says Marquard, an industrial engineering professor. "We're trying to understand how this specific technology contributes to Fallon's intervention goals for diabetics with high blood pressure."
The particular medical problem addressed by the study is that diabetics who don't control their blood pressure are vulnerable to many serious health risks, ranging from strokes and heart attacks to death.
Beyond that, the study seeks to develop a system of collaborative patient-provider management for many chronic health conditions that can be monitored and managed at home. The study uses hypertension control in diabetics as a test case, but the system it is testing is designed to be implemented inexpensively for a wide variety of medical conditions, clinical settings, and healthcare organizations.
The study involves recruiting 400 people with diabetes and uncontrolled hypertension who receive care through Fallon Clinics. Half of them will act as the control group by continuing to receive standard medical care. The other half will each receive an automated blood pressure cuff capable of uploading readings through a computer. The test patients will also receive instructions on how to use their cuffs at home, connect them to a computer, and upload their readings into the free Microsoft HealthVault personal health record system, which allows them to store their health information from many sources in one location so that it's always organized and available online. The blood pressure data will then be transferred automatically into Fallon Clinic's electronic health record system, where it will alert a team of diabetes-care nurses to patients who need medication changes.
Marquard's role is to assess how well these 200 test patients adopt and adapt to the technology. "In our case," says Marquard, "my team is testing how patients use electronic blood pressure instruments to connect with HealthVault. The goal is to control their blood pressure more effectively and adjust their medication in a much more timely and effective way. You need frequent and accurate blood pressure readings in order to change the medication appropriately."
One result of the project will be an intervention for patients whose blood pressure falls outside the target range. The research team will set up electronic flags to alert nurses whenever some kind of action with a patient is needed. In response to each alert, nurses can use standard protocols to alter that patient's blood pressure medications and thereby bring the blood pressure into a healthful range.
Marquard's team is also responsible for creating the instructional material that, along with in-person demonstrations by nurses, will teach patients how to use the technology. In addition, the study will measure a range of outcomes, including costs of the intervention, medication utilization, and a variety of patient-reported outcomes. Furthermore, researchers will interview and observe study subjects and care providers to gain a better understanding of factors affecting uptake and use of the intervention.
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