Multi-ethnic Multi-level Strategies and Behavioral Economics to Eliminate Hypertension Disparities in LA County.

项目概要/摘要 如果不解决以下问题，就无法消除美国种族/民族心血管健康差异： 高血压循证治疗的差异。在洛杉矶县（LAC）， 约801，000名拉丁裔、266，000名亚裔和244，000名非裔美国成年人患有高血压， 其中一半以上的人家庭收入低于联邦贫困线的200%。美洲和加勒比 卫生服务部（DHS），美国第二大市政卫生系统，病人，临床医生， 健康系统和社区因素导致高血压患病率、控制 和结果。导致LAC DHS中高血压差异的种族/族裔差距 与健康饮食、体力活动、肥胖、抗高血压药物治疗使用的差异有关， 药物治疗依从性、社区对高血压的认识以及社区层面的身体和社会 资源这些差距在LAC DHS中被广泛认为是解决高血压相关问题的障碍 种族/族裔健康差异，但健康生活方式做法和治疗方面的差异依然存在。我们提出 通过利用我们团队在多种族，多层次， 循证战略、社区/利益攸关方参与、公私伙伴关系、执行 科学和行为经济学。我们的建议是敏感的LAC国土安全部的使命提供高质量， 具有成本效益的护理，我们的重点是降低高血压相关的高成本 心脏和肾脏疾病。利用探索、准备、实施和维持（EPIS）框架， 我们提出了一个多层次的高血压控制干预，将完成EPIS探索/准备 在UG 3阶段和UG 4阶段的实施/维持阶段。与所有人合作， 51成人初级保健诊所在LAC DHS，我们的目标是：目标1（UG 3）：评估多层次（患者，临床医生， 卫生系统领导和社区）的障碍，促进者，和偏好的菜单文化- 量身定制的循证实践（EBP）和实施战略， 高血压控制。目标2（UG 3）：选择并系统地应用行为经济学来设计我们的 患者，临床医生和社区导向的实施策略，以最大限度地提高可接受性，吸收， 有效性目标3（UG 4）：在一个阶梯式楔形块中测试我们的实施策略的有效性 使用RE-AIM指导评估未控制的高血压的整群随机试验设计， 与非少数民族拉丁美洲和加勒比人口的比较，以及循证实践。

Project Summary/Abstract Eliminating racial/ethnic cardiovascular health disparities in the U.S. cannot be achieved without addressing disparities in evidence-based treatment of hypertension. In Los Angeles County (LAC), there are approximately, 801,000 Latino, 266,000 Asian, and 244,000 African American adults with hypertension, and more than half of these individuals have household income below 200% of the federal poverty level. In the LAC Department of Health Services (DHS), the second largest municipal health system in the US, patient, clinician, healthy system, and community factors contribute to substantial disparities in hypertension prevalence, control, and outcomes by race/ethnicity. Racial/ethnic gaps that contribute to hypertension disparities in LAC DHS relate to differences in healthy eating, physical activity, obesity, antihypertensive pharmacotherapy use, medication adherence, community awareness of hypertension, and community-level physical and social resources. These gaps are widely recognized in LAC DHS as barriers to addressing hypertension-related racial/ethnic health disparities, yet differences in healthy lifestyle practices and treatment persist. We propose to significantly reduce disparities in in LAC DHS by leveraging our team's expertise in multi-ethnic, multi-level evidence-based strategies, community/stakeholder engagement, public-private partnerships, implementation science, and behavioral economics. Our proposal is sensitive to LAC DHS' mission of providing high quality, cost-effective care, which we address with an ancillary focus on reducing the high cost of hypertension-related heart and kidney disease. Using the Exploration, Preparation, Implementation, Sustainment (EPIS) framework, we propose a multi-level intervention for hypertension control that will complete EPIS Exploration/Preparation stages in the UG3 phase and the Implementation/Sustainment stages in the UG4 phase. In partnership with all 51 adult primary care clinics in LAC DHS, our aims are: Aim 1 (UG3): Assess multi-level (patient, clinician, health system leadership, and community) barriers to, facilitators of, and preferences for a menu of culturally- tailored evidence-based practices (EBPs) and implementation strategies with established efficacy for hypertension control. Aim 2 (UG3): Select and systematically apply behavioral economics to the design of our patient-, clinician-, and community-directed implementation strategies to maximize acceptability, uptake, and effectiveness. Aim 3 (UG4): Test the effectiveness of our implementation strategies in a stepped-wedge cluster randomized trial design using RE-AIM to guide assessment of uncontrolled hypertension, disparities in comparison to non-minority LAC populations, and evidence-based practices.