ACHIEVE P1 - HTN

实现 P1 - HTN

• 批准号: 10494198
• 负责人: Robert Daniel Brook
• 金额: $ 69.12万
• 依托单位: WAYNE STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-24 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10494198
• 关键词: Address; Great Lakes Region; Prevention; cardiometabolism; health inequalities

PROJECT SUMMARY Hypertension is the leading risk factor for global morbidity and mortality. Even mild elevations in blood pressure (BP) are harmful whereby individuals with stage 1 hypertension are at double cardiovascular risk. Black adults suffer from a higher prevalence, worse control rates, and more frequent adverse health effects from high BP. They are also at heightened risk for an earlier accelerated progression from mild to more severe hypertension. Little progress has been made in mitigating health inequities related to high BP. Predominantly Black cities such as Detroit disproportionately suffer from nearly twice the national average mortality rate due to heart disease. Mounting evidence shows that pervasive negative social determinants of heath (SDoH) are major drivers of these inequities and represent a critical barrier to achieving BP control in Black hypertensives. Core issues include poor access to healthcare and a burdensome system for care linkage especially in under- resourced settings, low health education and literacy, and structural inadequacies in care delivery including a failure to address the spectrum of life circumstances that elevate BP and hinder the adoption of salutary lifestyle changes. In PROJECT 1 of the ACHIEVE GREATER research center, we propose an innovative approach to identify and control hypertension at its earliest stages in undiagnosed Black adults, potentially yielding an enormous benefit towards lifetime health equity. Using a hybrid type I effectiveness-implementation and quasi-experimental design, we will leverage our novel mobile health unite (MHU) platform to implement a program that links low risk Black adults with stage 1 hypertension to collaborative care delivered by non- physicians, community health workers (CHWs) and pharmacists, consisting of a personalized, adaptable approach to lifestyle and life circumstance (PAL2) intervention for 12-months. Core features of PAL2 include the ability to choose from a menu of readily available interventions that address individual negative SDoH, culturally sensitive health and lifestyle education, and adaptability over time according to its acceptance, effectiveness (home BP), and evolving patient needs. If BP remains ≥130/80 mm Hg after 6 months, a pharmacist-directed medical treatment algorithm will be added to achieve timely BP control. Program benefits including BP-lowering will be assessed during the implementation (12-months) and maintenance phases (year 2) after linkage to medical care. We aim to show the effectiveness of project 1 to lower home BP after 12 months in 500 Black patients with mild stage 1 hypertension living in disadvantaged communities in Detroit and to reach the target population. We also aim to evaluate the fidelity and outcomes of project 1 and examine its cost effectiveness. Improving care access by strategic MHU outreach, coupled with enhanced collaborative care, can effectively remove barriers, mitigate negative SDoH and improve BP control in Black adults with hypertension. PROJECT 1 of the ACHIEVE GREATER center represents a novel and scalable model to advance health equity in urban Black communities across the United States that continue to face disparities.

项目总结 高血压是全球发病率和死亡率的主要风险因素。即使是轻微的血压升高 (BP)是有害的，因此患有1级高血压的人面临双重心血管风险。黑人成年人 高血压患病率更高，控制率更差，对健康的不利影响也更频繁。 他们也面临着更早从轻度高血压加速发展到更严重高血压的高风险。 在减轻与高BP有关的健康不平等方面进展甚微。以黑人为主的城市 像底特律这样的城市由于心脏病死亡率几乎是全国平均水平的两倍 疾病。越来越多的证据表明，普遍存在的负面健康社会决定因素(SDoH)是主要的 这是这些不平等的驱动因素，是在黑人高血压患者中实现BP控制的关键障碍。堆芯 问题包括很难获得医疗保健和负担沉重的医疗联系制度，特别是在 资源匮乏、健康教育和识字率低，以及保健提供方面的结构性不足，包括 未能解决导致BP升高并阻碍采用有益健康的生活环境的范围 生活方式的改变。在实现更大研究中心的项目1中，我们提出了一种创新的 在未确诊的黑人成年人中识别和控制高血压的早期阶段的方法，可能 对终身健康公平产生了巨大的好处。使用混合的第一类有效性--实施 和准实验设计，我们将利用我们的新型移动医疗联合(MHU)平台来实施 将患有1期高血压的低风险黑人成年人与非政府组织提供的协作护理联系起来的计划 医生、社区卫生工作者(CHW)和药剂师，由个性化、适应性强的 生活方式和生活环境(PAL2)干预12个月。PAL2的核心功能包括 能够从针对个别消极SDoH的现成干预措施菜单中进行选择， 对文化敏感的健康和生活方式教育，以及根据其接受程度随着时间的推移而进行的适应性， 有效性(家庭BP)和不断变化的患者需求。如果6个月后BP仍为≥130/80 mm Hg，则a 将增加药剂师指导的医疗算法，实现对血压的及时控制。计划优势 包括降血压将在实施(12个月)和维护阶段(年)进行评估 2)医疗联动后。我们的目标是展示项目1在12岁后降低家庭血压的有效性 生活在底特律和底特律贫困社区的500名患有轻度高血压的黑人患者的6个月 以达到目标人群。我们还打算评估项目1的保真度和结果，并检查其 成本效益。通过战略性的MHU外展以及增强的协作性，改善护理的可及性 CARE，可以有效地消除障碍，缓解负SDoH，并改善患有 高血压。实现更大中心的项目1代表了一种新颖且可扩展的模式 促进美国城市黑人社区的健康公平，这些社区仍然面临着差距。