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

BP REACH：有心血管健康风险的安全网患者血压差异减少、公平和可及性

• 批准号: 10494285
• 负责人: ALEJANDRA CASILLAS
• 金额: $ 83.13万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 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/10494285
• 关键词: Blood Pressure; Ethnic group; Patients; Risk; cardiometabolism; cardiovascular health; disparity reduction; multi-ethnic; safety net

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.

项目摘要/摘要-P50研究＃1（BP覆盖范围） 高血压（HTN）是可预防死亡的主要因素，也是心血管的主要危险因素 （简历）事件。次优血压（BP）控制是最常见的属性简历风险因素，会计 对于缺血性心脏病负担的56％和中风负担的57％。 BP控制对于减少也至关重要 复发性简历事件的风险并改善中风和心肌梗塞（MI）的结果，但控制率 在这些患者中，仍然是次优的，特别是针对安全网健康服务的种族/少数民族人口 系统。除了较高的HTN负担和这些意识，治疗和控制率不足之外 弱势社区，健康的社会决定因素（SDOH），例如低社会经济地位（SES），有限 英语水平（LEP），保险不足 - 对BP控制构成了其他挑战。因此，减少 中风或MI后，BP控制中的种族/种族和SDOH根差异，需要创新干预措施， 解决医疗保健系统，患者和社区层面因素。过去的卫生系统干预已经 有效，尤其是那些利用基于慢性护理模型的干预措施的药物，药剂师主导的药物 管理和基于团队的管理等社区卫生工作者（CHW）。有干预措施 在患者层面上取得了成功，包括旨在扩大医疗保健访问的人（远程医疗：患者门户， 远程BP自我监控），健康素养和改善健康行为（运动和饮食）。洛杉矶 县人口为1100万，在种族和种族上是多种多样的，具有鲜明的社会经济和健康 差异。近一半的成年人出生在美国以外，18％的成年人收入<100％的联邦 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家医院为LAC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），以改善中风后 BP控制在此安全网中，目前正在HTN患者中进行一项初级预防试验。 基于我们测试多级复杂干预措施的经验，以改善这种低收入的BP控制 多种族环境，我们提出了BP REACH研究（降低血压差异，公平性和获取性 在具有心血管健康风险的安全网患者中）至：1）在文化和语言上设计多层次 量身定制，复杂的干预措施，通过优先级寻求弱势安全网患者的健康公平性 药剂师医学药物管理和CHW慢性疾病教育和基于 SDOH，减少具有LAC-DHS中史或MI史的多种族，多种族的BP 安全网; 2）测试这种干预对SBP的影响 LAC-DHS心脏病学和神经病学诊所的随机试验，3）确定介体对 收缩BP在干预措施中的主要结果。