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.

项目总结/摘要- P50研究#1（BP REACH） 高血压（HTN）是可预防死亡的主要原因，也是心血管疾病的主要危险因素。 (CV)事件血压（BP）控制不佳是最常见的CV风险因素，占 56%的缺血性心脏病负担和57%的中风负担。BP控制对于减少 卒中和心肌梗死（MI）后CV事件复发风险和结局改善，但控制率 在这些患者中，特别是对于安全网健康服务的种族/少数民族人群， 系统.除了HTN的负担更高以及对这些疾病的认识、治疗和控制率低之外， 弱势群体，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-对BP控制提出了额外的挑战。因此，为了减少 中风或心肌梗死后BP控制的种族/民族和SDOH根源的差异，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 有效，特别是那些利用慢性护理模式为基础的干预措施，药剂师主导的药物， 管理，以及社区卫生工作者（CHW）等团队管理。干预措施 在患者层面上成功的包括那些旨在扩大健康护理访问的方案（远程健康：患者门户， 远程BP自我监测）、健康素养和改善健康行为（锻炼和饮食）。洛杉矶 该县拥有1100万人口，民族和种族多样化，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%的人收入低于联邦的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），以改善卒中后 BP控制在这个安全网，目前正在进行一项初级预防试验与HTN的个人。 根据我们的经验，测试多层次的复杂干预措施，以改善这种低收入人群的BP控制。 在多民族背景下，我们提出了BP REACH研究（血压差异减少，公平性和可及性 在有心血管健康风险的安全网患者中）：1）设计一个多层次的、文化上和语言上的 为脆弱的安全网患者寻求健康公平，通过优先考虑 药剂师-医学药物管理和CHW慢性病教育和外展， SDOH，用于降低LAC-DHS中有卒中或MI病史的多种族、多民族个体的血压 2）在一个安全网中，测试这种干预对有中风或MI病史的个体SBP的影响。 LAC-DHS心脏病学和神经病学护理诊所的随机试验; 3）确定介质对 干预中收缩压的主要结局。