Hypertension Management in Minority and Low-income Populations

描述（由申请人提供）：本提案的总体目标是开发，适应，实施和评估在安全网络设置中照顾患有复杂合并症的种族/少数民族患者的高血压控制干预措施，包括慢性肾脏疾病（CKD）和糖尿病。Bibbins-Domingo博士是U54合作资助的联合PI，该合作资助评估临床交付的高血压控制干预措施，包括临床血压控制算法，以及旨在在综合健康交付系统中提供持续血压控制的文化量身定制的饮食干预；这些干预措施将构成本文研究的适应性干预措施的基础。该建议涉及以下目标：目标1。适应、实施和评估U54开发的高血压干预措施，以适应加州各地资源有限的安全网环境和目标2。使用新的微观模拟计算机模型确定有效高血压干预措施的基本要素，并建立基于人群的计算机模型（心血管疾病政策模型）来预测此类干预措施对健康差异的人群影响。该提案将加强Bibbins-Domingo博士的职业目标，即在实施科学方法方面进行教学和经验培训，发展多学科研究人员团队（包括肾病学家、心脏病学家和实施科学家），能够在资源有限的环境中为复杂的患者提供有效的预防干预措施。并将她之前的计算机建模工作整合到新的临床干预分析中。她将通过涉及广泛学科的受训者的指导研究来开展本文所述的工作。比宾斯-多明戈博士是

DESCRIPTION (provided by applicant): The overarching goal of this proposal is to develop, adapt, implement, and evaluate hypertension control interventions in safety-net settings caring for race/ethnic minority patients with complex co-morbid conditions including chronic kidney disease (CKD) and diabetes. Dr. Bibbins-Domingo is the joint PI of a U54 collaborative grant that evaluates a clinically-delivered hypertension control intervention consisting of a clinical blood pressure control algorithm, as well as a culturally-tailored dietary intervention aimed at sustained blood pressure control delivered in an integrated health delivery system; these interventions will form the basis for the adapted interventions studied here. The proposal addresses the following aims: Aim 1. To adapt, implement, and evaluate hypertension interventions developed in the U54 to resource- limited, safety net settings in across California, and Aim 2. To use a new micro-simulation computer model to determine essential elements of effective hypertension interventions and an established population-based computer model (the CVD Policy Model) to project population impact of such interventions on health disparities. This proposal will enhance Dr. Bibbins-Domingo's career goals to pursue didactic and experiential training in implementation science methodologies, to develop multi-disciplinary teams of researchers (including nephrologists, cardiologists, and implementation scientists) capable of developing effective prevention interventions for delivery in resource-limited settings caring for complex patients, and to integrate her prior computer modeling work in the analysis of new clinically-based interventions. She will conduct the work described here through mentored studies involving trainees from a broad set of disciplines. Dr. Bibbins- Domingo is the Director of the UCSF Center for Vulnerable Populations at San Francisco General Hospital and the Director of the Clinical and Translational Sciences Institute K Scholars Program that mentors junior faculty with career development awards. She has a long track record of mentoring trainees and junior faculty, including sub-specialists (i.e. nephrologist, cardiologists, endocrinologists) and several individuals from URM backgrounds. This proposal will develop new science while providing a rich training environment for junior investigators and furthering Dr. Bibbins-Domingo's own career development.