BP REACH: Blood Pressure disparities Reduction, Equity, and Access among safety net patients with Cardiovascular Health risk

项目摘要/摘要-P50研究#1(BP REACH) 高血压(HTN)是可预防死亡的主要因素，也是心血管疾病的主要危险因素 (CV)事件。血压控制不佳是最常见的心血管风险因素 对于56%的缺血性心脏病负担和57%的中风负担。BP控制也是降低 卒中和心肌梗死(MI)后心血管事件复发和预后改善的风险，但控制率 在这些患者中，尤其是在得到安全网保健服务的种族/少数民族人口中，情况仍然不佳 系统。除了HTN负担较高以及对这些疾病的认识、治疗和控制率较低之外 弱势社区，健康的社会决定因素(SDOH)，如低社会经济地位(SES)，有限 英语水平(LEP)和保险不足-给BP的控制带来了额外的挑战。因此，要减少 中风或心肌梗死后血压控制方面的种族/民族和SDOH根源差异，需要创新的干预措施， 解决医疗保健系统、患者和社区层面的因素。过去的卫生系统干预措施一直是 有效，特别是那些利用基于慢性护理模式的干预、药剂师领导的药物 管理，以及基于团队的管理，如社区卫生工作者(CHW)。干预措施有 在患者层面取得成功的包括那些旨在扩大医疗服务访问的项目(远程医疗：患者门户、 远程血压自我监测)，健康素养，并改善健康行为(锻炼和饮食)。洛杉矶 该县有1100万人口，种族和种族多样，社会经济和健康状况严峻 差距。近一半的成年人出生在美国以外，18%的人有联邦收入&100% 贫困水平。洛杉矶县卫生服务部(LAC-DHS)系统，第二大 美国的市政卫生系统通过4家医院和4家医院为拉丁美洲最脆弱的居民提供服务 23个门诊护理中心。我们已经进行了先前的随机对照试验(RCT)来改善卒中后 英国石油公司在这一安全网中进行了控制，目前正在对HTN患者进行一级预防试验。 根据我们测试多层次复杂干预措施的经验，在这一低收入地区改善BP控制 在多种族背景下，我们提出了BP REACH研究(减少血压差异、公平和获得 在有心血管健康风险的安全网患者中)到：1)设计一个多层次的、文化和语言的 量身定制的复杂干预措施，通过优先排序，为脆弱的安全网患者寻求健康公平 药剂师-医疗药物管理和CHW慢性病教育和外展 SDOH，在LAC-DHS中降低有中风或心肌梗塞病史的多种族、多民族个人的血压 安全网；2)测试这种干预对有中风或心肌梗塞病史的个体的SBP的影响 在LAC-DHS心脏科和神经科护理诊所进行的随机试验和3)确定介质对 介入治疗中收缩压的主要结果。

Project Summary/Abstract - P50 Study #1 (BP REACH) Hypertension (HTN) is the leading contributor to preventable death, and a major risk factor for cardiovascular (CV) events. Suboptimal blood pressure (BP) control is the most common attributable CV risk factor, accounting for 56% of the burden of ischemic heart disease and 57% of stroke burden. BP control is also critical for reducing risk of recurrent CV events and improving outcomes after stroke and myocardial infarction (MI), yet control rates in these patients remain suboptimal, particularly for racial/ethnic minority populations served by safety net health systems. In addition to a higher burden of HTN and poor awareness, treatment, and control rates for these vulnerable communities, social determinants of health (SDOH) like low socioeconomic status (SES), limited English proficiency (LEP), and underinsurance- pose additional challenges to BP control. Thus, to reduce racial/ethnic and SDOH-rooted disparities in BP control after stroke or MI, innovative interventions are needed, addressing healthcare system, patient, and community level factors. Past health system interventions have been effective, particularly those that utilize chronic care model-based interventions, pharmacist-led medication management, and team-based management like community health workers (CHWs). Interventions that have succeeded at the patient level include those designed to expand health care access (telehealth: patient portal, remote BP self-monitoring), health literacy, and improve health behaviors (exercise and diet). Los Angeles County, with a population of 11 million, is ethnically and racially diverse, with stark socioeconomic and health disparities. Nearly half of adults are born outside the United States and 18% have incomes <100% federal poverty level. The Los Angeles County Department of Health Services (LAC-DHS) system, the 2nd largest municipal health system in the United States serves LAC's most vulnerable residents through 4 hospitals and 23 ambulatory care centers. We have conducted prior randomized controlled trials (RCTs) to improve post-stroke BP control in this safety net, and are currently conducting a primary prevention trial among individuals with HTN. Building upon our experience testing multilevel complex interventions for improving BP control in this low-income multi-ethnic setting, we propose the BP REACH study (Blood Pressure disparities Reduction, Equity, and Access among safety net patients with Cardiovascular Health risk) to: 1) Design a multilevel, culturally and linguistically tailored, complex intervention that seeks health equity for vulnerable safety net patients by prioritizing pharmacist-med medication management and CHW chronic disease education and outreach based in the SDOH, to reduce BP among multi-racial, multi-ethnic individuals with a history of stroke or MI in the LAC-DHS safety-net; 2) Test the impact of this intervention on SBP for individuals with a history of stroke or MI in a randomized trial in LAC-DHS cardiology and neurology care clinics and 3) Determine the effect of mediators on the primary outcome of systolic BP in the intervention.