IMPROVING THE TREATMENT AND CONTROL OF HYPERTENSION

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Candidate: Karen Margolis, M.D., M.P.H., is a member of the Berman Center for Outcomes and Clinical Research at the Minneapolis Medical Research Foundation, and staff physician at Hennepin County Medical Center, a teaching hospital affiliated with the University of Minnesota. Dr. Margolis is interested in finding interventions which bring patients, physicians and the system of care together to implement effective medical care, specifically in the area of cardiovascular disease prevention. Career Objectives. Dr. Margolis' immediate career objectives include: (1) advanced course work in epidemiology, biostatistics, health services research, study design and analysis; (2) work with the Berman Center multi-center clinical trials and prospective studies; (3) work with mentor to develop and evaluate research direction, skills and experience; (4) obtain funding for and implement pilot and full-scale studies of randomized trial of physician incentives for improving the control of hypertension in a managed care organization; and (5) develop other related research projects. Dr. Margolis' long-term career objectives include attaining independence as an investigator in the field of patient-oriented cardiovascular disease prevention research and incorporating the theme of physician and patient adoption of effective interventions in a system of care for the prevention of cardiovascular disease morbidity and mortality. Research Plan. During the five year period of the award, Dr. Margolis plans to undertake at least one major clinical trial preceded by a pilot study for that trial. The clinical trial and pilot study are entitled "Program for Improving the Treatment and Control of Hypertension (PITCH)" and will involve testing the hypothesis that clinics in a managed care organization receiving funding to design their own program for improving the control of hypertension will have a higher percentage of hypertensives with controlled blood pressure compared to both clinics given similar funding for financial incentives (provided directly to physicians based on performance) and control clinics given no financial incentives. Dr. Margolis also has planned several other related projects which include: (1) study of patient attitudes towards physician financial incentives and satisfaction with care in PITCH; (2) study of impact of physician financial incentives in PITCH on medical care other than hypertension; and (3) the role of patient health state preferences in acceptance of hypertension treatment and control of hypertension.