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

该提案的中心目标是严格比较两种旨在改善血液质量的策略。 压力（BP）控制在初级保健实践中服务于农村东南非裔美国人， 生活在“黑带”的社会经济地位。黑带位于中风带的中心，地理位置优越， 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 实践促进（PF）是一种高度定制的、分阶段的方法， 实施流程和结构变革，可以提高护理质量，改善患者和工作人员 但是，关于其改善血压控制等结果的能力的证据较少。一个替代 改善CVD风险因素的方法，更注重关系，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，同伴教练是有效的， 黑带社区，那里对医疗保健系统的不信任是常见的。利用良好建立的 基于社区的伙伴关系和RE-AIM实施框架，我们的UH 2具体目标是：1。 参与农村初级保健实践，高血压（HTN）患者，同伴教练和社区咨询 AL和NC的董事会合作完成PF干预和同伴指导干预， 旨在改善非裔美国人的血压。2.为试验创建数据系统。我们的UH 3具体目标 是：3.在每个实践中招募80个实践和25名患有不受控制的HTN的非洲裔美国人患者（总计 n=2000）在一个随机分组，对照务实的实施试验，比较两个多- 在UH 2阶段完成的多层次干预措施，使用2 x 2 析因设计我们假设这两种干预措施都比加强常规护理更能改善血压， 两种干预措施一起实施将比任何一种干预措施都能更好地改善BP 一个人虽然我们的目标是控制75%的参与干预患者的血压，但该试验旨在 检测联合干预和增强干预之间BP控制（主要结局）的差异>15% 常规护理手臂次要结局将包括基线和随访之间的组平均BP差异- 上;生活质量;病人满意度;医疗保健利用;和提供者和工作人员的满意度。这项研究是 旨在研究性别、年龄、抑郁和健康素养/算术方面的差异。目标4。建立 在整个黑带地区使用广泛的过程数据， 促进未来的实施，包括实践特征、患者特征、干预 实施变量和保真度措施，以及焦点小组和病人，同行采访， 教练、辅导员、实践人员和临床医生。我们拥有丰富的社区同行经验 教练干预; PF干预; CVD中的健康差异研究;以及大型多中心随机 对照试验参与真实世界的实践，确保项目的成功。

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.