Home-Based Blood Pressure Interventions for African Americans

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DESCRIPTION (provided by applicant): This study will conduct a randomized trial to examine the effectiveness and cost-effectiveness of two organizational interventions aimed at improving BP control among a high-risk, African American home care population. The two interventions to be tested include (i) a "basic" intervention delivering key "just-in-time" information to nurses, physicians and patients while the patient is receiving traditional post-acute home health care; and (ii) an "augmented" intervention transitioning patients to a Home-Based HTN Support Program that extends the information, monitoring and feedback available to patients and primary care physicians for an 18-month period beyond an index home care admission. The interventions will be assessed relative to usual care and to each other. Randomization will occur at the nurse level, and a nurse's initial random assignment to a specific group (usual care, basic treatment or augmented treatment) will determine the status for all new patients allocated to that particular nurse's care for the duration of the study. The analysis will estimate the impact of the basic and augmented interventions on nursing practices and processes of care, on patient hypertension management (e.g. medication adherence) and BP outcomes, and on costs. Behaviors and outcomes will be measured at fixed points in time, and analyses will adjust for selected nurse characteristics, as well as for patient characteristics including age, gender, BP, co-morbidities and informal support at admission. Measures of these dependent variables will be derived from a combination of primary and secondary data, including patient records, patient assessment instruments, patient interviews, home BP monitors and urine tests, and administrative files. Regression models will be used to control for differences among nurses in the three groups with respect to characteristics that might influence practices or processes of care. Regression models also will be used to control for differences across patient groups that might influence behavior, service use, BP or other health outcomes. Estimates of treatment-control group differences (for both treatments) generated by these models will be tested for statistical significance to determine the extent to which observed differences at the nurse and patient levels are attributable to the alternative intervention strategies.