The RICH LIFE Project: A cluster randomized pragmatic trial comparing the effectiveness of health system only vs. health system Plus a collaborative/stepped care intervention to reduce hypertension disparities
The RICH LIFE Project: A cluster randomized pragmatic trial comparing the effectiveness of health system only vs. health system Plus a collaborative/stepped care intervention to reduce hypertension disparities
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DOI：
10.1016/j.ahj.2020.05.001
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发表时间：
2020-08-01
影响因子：
4.8
通讯作者：
Wang, Nae-Yuh
中科院分区：
文献类型：
--
作者：
Cooper, Lisa A.;Marsteller, Jill A.;Wang, Nae-Yuh
在美国，即使是在医疗保健系统中定期就诊的患者中，高血压和其他心血管疾病危险因素的控制也存在差异。现有的方法很少明确解决高血压护理和控制的差异。本文介绍了丰富的生活项目（减少高血压护理中的不公平现象：方法RICH LIFE是一项两组、群集随机试验，比较了加强护理标准“标准护理+”（SCP）与多水平干预“协作护理/阶梯护理”（CC/SC）的有效性，在马里兰州和宾夕法尼亚州的30个初级保健诊所治疗的1890名患有不受控制的高血压和至少一种其他心血管疾病风险因素的成年人中，改善血压（BP）控制和患者激活，并减少BP控制的差异。随机分配到SCP组的15个实践接受标准化BP测量培训;种族/民族特定的BP控制率审计和反馈;以及管理实践，质量改进和减少差异的季度网络研讨会。CC/SC组中的15个实践接受SCP干预措施，加上实施具有阶梯式护理组成部分的协作护理模式（社区卫生工作者转诊和虚拟专家小组咨询）。主要临床结局是血压控制（
Background Disparities in the control of hypertension and other cardiovascular disease risk factors are well-documented in the United States, even among patients seen regularly in the healthcare system. Few existing approaches explicitly address disparities in hypertension care and control. This paper describes the RICH LIFE Project (Reducing Inequities in Care of Hypertension: Lifestyle Improvement for Everyone) design.Methods RICH LIFE is a two.arm, cluster-randomized trial, comparing the effectiveness of enhanced standard of care, "Standard of Care Plus" (SCP), to a multi-level intervention, "Collaborative Care/Stepped Care" (CC/SC), for improving blood pressure (BP) control and patient activation and reducing disparities in BP control among 1890 adults with uncontrolled hypertension and at least one other cardiovascular disease risk factor treated at 30 primary care practices in Maryland and Pennsylvania. Fifteen practices randomized to the SCP arm receive standardized BP measurement training; race/ethnicity-specific audit and feedback of BP control rates; and quarterly webinars in management practices, quality improvement and disparities reduction. Fifteen practices in the CC/SC arm receive the SCP interventions plus implementation of the collaborative care model with stepped-care components (community health worker referrals and virtual specialist-panel consults). The primary clinical outcome is BP control (