Leveraging electronic health record tools to reduce health disparities for patients with uncontrolled hypertension

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Hypertension affects one in three US adults, yet only 50% have their blood pressure adequately controlled. Hypertension is twice as prevalent in black adults than non-Hispanic whites; consequently, blacks are 2 to 3 times more likely to die of hypertension-related heart disease than their white counterparts. While many factors contribute to these disparities, a lack of treatment intensification, the underuse or prescribing of racially-based oral antihypertensives, and suboptimal follow-up care are thought to be central in the context of racial/ethnic disparities. Health information technology (health IT) solutions, such as decision support in electronic health record (EHR) systems, could help reduce these gaps in care, but few studies have evaluated the use of these strategies in health systems caring for a large population of minority patients. Similarly, while decision support has been widely-used, it has rarely been employed to emphasize racial differences in care, to support racially- sensitive treatment recommendations, or to help address barriers to care that are more common among minority subgroups. Decision support has generally been used as a single approach and has not been integrated with other health IT strategies like patient portals to improve patient communication. More generally, most tools have also not been designed using principles from the rapidly-emerging field of behavioral science. To this end, we propose a pragmatic randomized effectiveness-implementation hybrid type 2 trial to test the impact of a racially-tailored multicomponent health IT intervention on racial and ethnic disparities in hypertension control. This trial will be conducted at Advocate Health, the largest integrated delivery network in Illinois, which serves a multi-ethnic patient population throughout the Chicago area and has extensive experience conducting research studies and pragmatic clinical trials with numerous academic partners. The specific aims of the study are to: (1) design and pilot test racially-informed health IT tools to address racial/ethnic disparities in hypertension control using a patient advisory board and provider focus groups; (2) conduct a 2-arm pragmatic cluster randomized trial with partial crossover to determine whether racially- informed health IT tools improve blood pressure control and reduce disparities in minority populations; and (3) evaluate the acceptability and adoptability of the health IT interventions by patients, providers, and clinics, including whether the intervention reduces disparities in adoption rates of patient portals. Using a rigorous randomized design, we have proposed a pragmatic and scalable approach to optimizing health IT tools to address disparities. Our multidisciplinary study team consists of experts in racial/ethnic disparities, hypertension, health IT, patient and provider behavior change, and pragmatic trials. The expected overall impact of this innovative proposal is that it will fundamentally advance how health IT can be optimized to improve health disparities in ways that are scalable and integrated into healthcare systems.