Community Intervention to Reduce CardiovascuLar Disease in Chicago (CIRCL-Chicago)

1.项目摘要/摘要 在美国，每3个成年人中就有1人患有高血压，每年有41万人死于高血压。高血压和 其相关的并发症对生活在城市地区的少数群体的影响不成比例。在芝加哥， 健康状况指标显示，黑人和白人居民之间的差距正在恶化， 高血压、心脏病和中风聚集在以黑人为主的南部和西部。凯撒 Permanente表明，在一个大型、集成的 北加州的医疗系统显著提高了血压控制率。然而，目前还不清楚 以卫生系统为中心的干预措施是否可以适应其他环境，特别是资源不足的情况 城市社区。因此，我们的总体目标是支持以社区为中心的设计和调整 凯撒捆绑包。我们的适应将Kaiser捆绑转移到南侧的教堂内 芝加哥，美国医疗服务最匮乏的社区之一。拟议的干预措施 与Kaiser捆绑包中相同(例如，登记/审计和反馈、简化的治疗方案、准确 血压测量)，但捆绑组件的实现将适用于交付 在社区里。干预将由当地社区卫生工作者和部委协助者进行， 以社区内的卫生所和医院为支撑，都通过一个通用的数据平台连接起来。 因此，我们提议的项目将确定最佳战略，以支持采用、忠实实施和 Kaiser捆绑包在社区环境中的可持续性。拟议的研究将遵循探索， 严格评估准备、实施和维持(EPIS)流程模型和实施 使用多种方法实现覆盖范围、有效性、采用、实施和维护(RE- 目的)评价框架。我们的具体目标是：目标1：召集社区利益攸关方以适应 使用动态适应过程模型的实施战略。目标2：设计、实施和 评估试点项目，以优化社区内的实施战略。目标3：执行、 测试和评估通过基于信仰的组织控制高血压的适当实施战略 在芝加哥的南边。我们的总体实施是一种混合型2有效性实施设计 总部设在一个主要社区区域(芝加哥南部)和两个环境(教堂和诊所)。这个 总体研究结果是公共健康影响指标(REACH*干预效果大小)。目标4： 在内部向社区利益相关者传播调查结果，并通过创建社区向外部传播 实施工具包。

1. Project Summary/Abstract Hypertension affects 1 in every 3 adults in the US and contributes to 410,000 deaths annually. Hypertension and its associated complications disproportionately affect minority populations living in urban areas. In Chicago, health status indicators show worsening disparities between black and white residents, with the highest rates of hypertension, heart disease, and stroke clustering in the predominantly black South and West Sides. Kaiser Permanente demonstrated that a bundle of evidence-based interventions implemented within a large, integrated health system in Northern California significantly increased blood pressure control rates. However, it is unclear whether a health system centered intervention can be adapted to other settings, particularly under-resourced urban communities. Therefore, our overall goal is to support a community-centered design and adaptation of the Kaiser bundle. Our adaptation shifts the Kaiser bundle to be centered within churches within the South Side of Chicago, one of the most medically underserved communities in the United States. The proposed interventions are the same as in the Kaiser bundle (e.g., registry/audit and feedback, simplified treatment regimens, accurate Blood Pressure measurement) but implementation of the components of the bundle will be adapted for delivery in the community. The intervention will be carried out by local community health workers and ministry facilitators, with health clinics and hospitals in the community as support, all connected through a common data platform. Thus, our proposed project will identify the best strategies to support adoption, implementation with fidelity, and sustainability of the Kaiser bundle in the community setting. The proposed study will follow the Exploration, Preparation, Implementation and Sustainment (EPIS) process model and implementation is rigorously evaluated using a multimethod approach to the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE- AIM) evaluation framework. Our specific aims are: Aim 1: Convene community stakeholders in order to adapt implementation strategies using the Dynamic Adaptation Process model. Aim 2: Design, implement, and evaluate pilot projects in order to optimize implementation strategies within our community. Aim 3: Implement, test and evaluate an adapted implementation strategy to control hypertension through faith-based organizations in the South Side of Chicago. Our overall implementation is a hybrid Type 2 effectiveness–implementation design based within one primary community area (South Side Chicago) and in two settings (church and clinic). The overall study outcome is the Public Health Impact metric (reach * effect size of the intervention). Aim 4: Disseminate findings internally to community stakeholders and externally through creation of community implementation toolkits.