Collaboration to Improve Blood Pressure in the US Black Belt- Addressing the Triple Threat

合作改善美国黑带血压——应对三重威胁

• 批准号: 10191671
• 负责人: Andrea L Cherrington
• 金额: $ 11.6万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-31 至 2022-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10191671
• 关键词: Address; Adult; Affect; African American; Age; Alabama; Algorithms; Behavior Therapy; Blood Pressure; Cardiovascular Diseases; Caring; Characteristics; Client satisfaction; Cluster randomized trial; Collaborations; Communities; Custom; Data; Diabetes Mellitus; Effectiveness; Electronic Health Record; Enrollment; Ethnic Origin; Feedback; Focus Groups; Future; Geographic Locations; Goals; Group Interviews; Health; Healthcare Systems; Heart; Heart Diseases; Hypertension; Individual; Information Systems; Intervention; Intervention Trial; Maryland; Measures; Medication Management; Mental Depression; Minority; North Carolina; Outcome; Patients; Phase; Poverty; Practice based research; Primary Health Care; Process; Protocols documentation; Provider; Quality of Care; Quality of life; Randomized; Randomized Controlled Trials; Registries; Reporting; Research; Resources; Rest; Risk Factors; Risk Reduction; Rural; Sex Differences; Site; Speed; Stretching; Stroke; Stroke Belt; Structure; System; Testing; Texas; United States Agency for Healthcare Research and Quality; Universities; agricultural region; base; blood pressure medication; blood pressure regulation; cardiovascular disorder prevention; cardiovascular disorder risk; design; evidence base; experience; follow-up; health care service utilization; health disparity; health literacy; high risk; hypertension control; implementation trial; improved; improved outcome; low socioeconomic status; mathematical ability; mortality; peer coaching; primary outcome; rural residence; satisfaction; secondary outcome; success; treatment as usual; trial comparing; usual care arm

The central objective of this proposal is to rigorously compare two strategies designed to improve blood pressure (BP) control in primary care practices serving rural Southeastern African Americans with low socioeconomic status living in the “Black Belt”. The Black Belt is in the heart of the Stroke Belt, a geographic area long recognized to have the highest cardiovascular disease mortality in the US. We draw on the growing evidence that practice facilitation (PF), a highly customized, staged approach to helping practices to implement process and structural changes, can enhance the quality of care and improve patient and staff satisfaction, but there is less evidence on its ability to improve outcomes such as BP control. An alternate approach to improving CVD risk factors that is more relationship-focused and with growing evidence of effectiveness involves the use of peer coaches. We and others have shown that peer coaches are effective in Black Belt communities, where mistrust of the healthcare system is common. Using well-established community-based partnerships and the RE-AIM implementation framework, our UH2 Specific Aims are: 1. Engage rural primary care practices, hypertension (HTN) patients, peer coaches, and Community Advisory Boards in AL and NC to collaboratively finalize a PF intervention and a peer coaching intervention, both designed to improve BP in African Americans. 2. Create the data systems for the trial. Our UH3 Specific Aims are: 3. Enroll 80 practices and 25 African American patients with uncontrolled HTN at each practice (total n=2000) in a cluster-randomized, controlled pragmatic implementation trial to compare the two multi- component, multi-level interventions finalized in the UH2 phase with enhanced usual care using a 2 x 2 factorial design. We hypothesize that both interventions will improve BP more than enhanced usual care, and that both interventions delivered together will result in greater improvements in BP than either intervention alone. While we aim to control BP in 75% of participating intervention patients overall, the trial is designed to detect >15% difference in BP control (primary outcome) between the combined intervention and the enhanced usual care arms. Secondary outcomes will include group mean BP differences between baseline and follow- up; quality of life; patient satisfaction; healthcare utilization; and provider and staff satisfaction. The study is designed to examine differences by sex, age, depression, and health literacy/numeracy. Aim 4. Establish scalability of the intervention throughout the entire Black Belt region using extensive process data intended to facilitate future implementation, including practice characteristics, patient characteristics, intervention implementation variables and fidelity measures, as well as focus groups and interviews with patients, peer coaches, facilitators, practice staff, and clinicians. We have extensive experience with community-based peer coaching interventions; PF interventions; health disparities research in CVD; and large multi-site randomized controlled trials engaging real-world practices, assuring the success of the project.

该提案的中心目标是严格比较两种旨在改善血液的策略 为农村东南非裔美国人提供低血压的初级保健实践中的压力（BP）控制 生活在“黑带”的社会经济地位。黑带位于中风带的中心，中风带是一个地理区域。 该地区长期以来被认为是美国心血管疾病死亡率最高的地区。我们利用不断增长的 有证据表明实践促进（PF）是一种高度定制的、分阶段的方法，旨在帮助实践 实施流程和结构变革，可以提高护理质量并改善患者和员工 满意度，但很少有证据表明其改善血压控制等结果的能力。替补 改善 CVD 危险因素的方法更加注重关系，并且越来越多的证据表明 有效性涉及使用同伴教练。我们和其他人已经证明同伴教练在以下方面是有效的： 黑带社区，对医疗保健系统的不信任很常见。使用成熟的 基于社区的伙伴关系和 RE-AIM 实施框架，我们的 UH2 具体目标是： 1. 让农村初级保健实践、高血压 (HTN) 患者、同伴教练和社区咨询参与进来 阿拉巴马州和北卡罗来纳州的董事会将共同完成 PF 干预和同伴辅导干预 旨在改善非裔美国人的血压。 2. 创建试验数据系统。我们的 UH3 具体目标 3. 招募 80 家诊所，每家诊所招收 25 名未受控制的高血压非裔美国患者（总计 n=2000）在集群随机、受控实用实施试验中比较两个多 在 UH2 阶段完成的多​​层次干预措施，并使用 2 x 2 强化常规护理 因子设计。我们假设这两种干预措施比加强常规护理更能改善血压，并且 两种干预措施一起实施将比任何一种干预措施带来更大的血压改善 独自的。虽然我们的目标是总体上控制 75% 参与干预患者的血压，但该试验的目的是 检测联合干预和强化干预之间血压控制（主要结果）>15% 的差异 平时护理手臂。次要结果将包括基线和随访期间的组平均血压差异。 向上;生活质量；患者满意度；医疗保健利用；以及供应商和员工的满意度。该研究是 旨在检查性别、年龄、抑郁症和健康素养/算术能力的差异。目标 4. 建立 使用广泛的过程数据在整个黑带地区进行干预的可扩展性 促进未来的实施，包括实践特征、患者特征、干预措施 实施变量和忠诚度措施，以及焦点小组和对患者、同行的访谈 教练、辅导员、实践人员和临床医生。我们在与社区同行打交道方面拥有丰富的经验 辅导干预； PF 干预；心血管疾病的健康差异研究；和大型多站点随机 对照试验涉及现实世界的实践，确保项目的成功。

项目成果

The Key Driver Implementation Scale (KDIS) for practice facilitators: Psychometric testing in the "Southeastern collaboration to improve blood pressure control" trial.

• DOI: 10.1371/journal.pone.0272816
• 发表时间: 2022
• 期刊: PloS one
• 影响因子: 3.7

Implementing practice facilitation in research: how facilitators spend their time guiding practices to improve blood pressure control.

• DOI: 10.1186/s43058-023-00470-y
• 发表时间: 2023-07-31
• 期刊: Implementation science communications

Greater Social Functioning Associated With Lower Depressive Symptomatology Among Black Belt African Americans Enrolled in the Southeastern Collaboration to Improve Blood Pressure Control Study.

参加东南部合作改善血压控制研究的黑带非裔美国人的更大的社会功能与较低的抑郁症状相关。

• DOI: 10.4088/pcc.21m02988
• 发表时间: 2022
• 期刊: The primary care companion for CNS disorders
• 作者: Finch,AnthonyJ;Ringel,JoannaBryan;Dargar,Savira;Halladay,Jacqueline;Cene,Crystal;Cherrington,Andrea;Cummings,Doyle;Safford,MonikaM
• 通讯作者: Safford,MonikaM