Race/ethnic differences in guideline recommended hypertension medications in VHA

VHA 指南推荐高血压药物的种族/民族差异

• 批准号: 9761839
• 负责人: April F Mohanty
• 金额: --
• 依托单位: VA SALT LAKE CITY HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-02-01 至 2023-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9761839
• 关键词: Address; Adult; Age; Algorithms; Black race; Blood Pressure; Body mass index; Cardiovascular Diseases; Cardiovascular system; Caring; Cessation of life; Chronic; Chronic Kidney Failure; Cities; Clinical Trials; Confidence Intervals; Data; Development; Diabetes Mellitus; Diagnosis; Diastolic blood pressure; Ensure; Epidemiologist; Ethnic Origin; Event; Fellowship; Female; Foundations; Future; Goals; Guidelines; Health Services; Health Services Administration; Health Services Research; Healthcare; Healthcare Systems; Heart; Heart failure; Hispanics; Historically Black Colleges and Universities; Hypertension; Incidence; Inequality; Informatics; Intervention; Intervention Trial; Interview; Joints; Lead; Life; Medical Informatics; Medical center; Methods; Minority; Minority Groups; Modeling; Myocardial Infarction; Natural Language Processing; Outcome; Patients; Pharmaceutical Preparations; Plant Roots; Population; Practice Management; Prevalence; Provider; Publishing; Race; Randomized Controlled Trials; Recording of previous events; Reporting; Research; Research Personnel; Research Training; Retrospective cohort study; Risk Factors; Safety; Scientist; Services; Site; Sodium Chloride; Stroke; Telephone Interviews; Testing; Time; Training; Training Programs; Treatment Protocols; Treatment outcome; United States; United States National Institutes of Health; Veterans; acute coronary syndrome; base; blood pressure intervention; blood pressure regulation; cardiovascular disorder prevention; cardiovascular disorder risk; career; ethnic difference; ethnic minority population; evidence base; follow-up; hazard; health administration; health disparity; health inequalities; high risk; hypertension control; hypertension treatment; implementation research; improved; interest; male; minority scientist; mortality; patient oriented; racial and ethnic; racial difference; racial disparity; racial minority; satisfaction; sex; tool; usability

Among Veterans, hypertension is the most common chronic condition with a prevalence of 37% and can lead to stroke, myocardial infarction, chronic kidney disease, and heart failure. Among blacks, hypertension occurs earlier in life, is more prevalent and severe, and is less likely to be controlled. While control of hypertension has significantly improved over recent years in the Veterans Affairs (VA), from 46% in 2000 to 76% in 2010, disparities persist among blacks, and reasons are not well understood. The Joint National Committee (JNC) publishes guidelines on evidence-based medications for hypertension treatment. However, controversy remains regarding the target blood pressure (BP) to achieve with therapy. The recently published Systolic Blood Pressure Intervention Trial (SPRINT), a landmark clinical trial, is anticipated to lead to changes in hypertension practices for patients with increased cardiovascular disease risk and without a history of diabetes. Investigators reported a reduction of systolic BP to <120 mm Hg (vs < 140 mm Hg) was associated with a lower incidence of cardiovascular-events, - mortality, and all-cause mortality for both black and nonblack patients. The extent to which systolic BP control of <120 mm Hg is achieved in VA is unknown. Special focus is needed for the VA group at highest risk for uncontrolled BP, black Veterans. This group is expected to grow at least 3% from 11% of Veterans in 2014 to 14% by 2034. The goals of this project are: Aim 1. To examine, one year following Veterans’ incident hypertension diagnosis, patient level predictors of (1) use of guideline-recommended medications and (2) BP control among Veterans and to describe how the effect of these predictors varies by race; Aim 2. To identify provider and facility level predictors of use of guideline-recommended medications and BP control among Veterans with incident hypertension and to describe how the effect of these predictors varies by race using mixed-methods; and Aim 3. To develop and pilot test a provider/team focused informatics strategy to facilitate hypertension control with enhanced features for racial minority Veterans. Aims 1-2 involve a longitudinal retrospective cohort study of black and white Veterans from VA facilities nationwide with incident hypertension 2007-2012 and examining outcomes of (1) prescriptions for JNC7 guideline-recommended medications and (2) controlled hypertension 1-year after incident hypertension diagnosis. Using regression models, patient- (Aim 1), provider- and facility-level (Aim 2) variables will be identified that are predictors for not receiving of guideline-recommended medications for hypertension and/or lack of BP control at 1-year of follow-up. Aims 1-2 further examine how these predictors vary by race. The qualitative analysis for Aim 2 will include chart review using natural language processing methods and a total of 36 telephone interviews with Patient Aligned Care Team (PACT) providers from 4 VA facilities (identified from Aim 1 and Aim 2) to ascertain reasons for not prescribing guideline-recommended hypertension medications among patients identified from Aims 1-2.The Consolidated Framework of Implementation Research will be used to conduct these interviews. Aim 3 includes the development of a trained and tested algorithm (from retrospective data) that incorporates SPRINT and Aim 1-2 findings and enhanced features for racial minorities based. A scenario based mockup with 20 Salt Lake City VA Medical Center (SLCVAMC) PACT providers will be used to determine initial tool feasibility, usability, acceptance, provider interest, safety, and satisfaction.

在退伍军人中，高血压是最常见的慢性疾病，患病率为37%。 并可导致中风、心肌梗塞、慢性肾病和心力衰竭。之间 黑人，高血压发生在生命的早期，更普遍和严重， 控制。虽然近年来高血压的控制有了显著改善， 退伍军人事务部（VA），从2000年的46%到2010年的76%，黑人之间的差距仍然存在， 原因不太清楚。全国联合委员会（JNC）发布了以下指导方针： 用于高血压治疗的循证药物。然而，争议依然存在 关于通过治疗达到的目标血压（BP）。最近出版的 收缩压干预试验（SPRINT）是一项具有里程碑意义的临床试验， 导致心血管疾病增加的患者的高血压实践发生变化 风险和无糖尿病史。研究者报告收缩压降低至<120 mmHg（vs < 140 mmHg）与心血管事件发生率较低相关， 死亡率，以及黑人和非黑人患者的全因死亡率。的程度 VA患者收缩压控制在<120 mm Hg尚不清楚。需要特别关注 退伍军人管理局的黑人退伍军人是血压失控风险最高的人群。预计这一群体将增长 从2014年的11%到2034年的14%。该项目的目标是：目标1。 在退伍军人高血压诊断一年后， （1）使用指南推荐的药物和（2）血压控制的预测因素， 退伍军人和描述这些预测因素的影响如何因种族而异;目的2.以识别 使用指南推荐药物和BP的提供者和机构水平预测因素 控制退伍军人与事件高血压，并描述如何影响这些 使用混合方法，预测因素因种族而异;目标3。开发和试点测试 以提供者/团队为中心的信息学策略，以促进高血压控制， 少数民族退伍军人的特点。目的1-2涉及纵向回顾性队列研究 2007-2012年全国退伍军人事务部设施中发生高血压的黑人和白色退伍军人 并检查（1）JNC 7指南推荐药物处方的结果， (2)高血压诊断后1年控制高血压。使用回归 模型、患者（目标1）、提供者和机构级别（目标2）变量将被确定， 未接受指南推荐的高血压药物治疗和/或缺乏 1年随访时血压控制。目标1-2进一步研究这些预测因子如何随 比赛目标2的定性分析将包括使用自然语言的图表审查 处理方法，并与患者对齐护理团队进行了共计36次电话访谈 （PACT）提供者从4 VA设施（从目标1和目标2确定），以确定原因， 在确定的患者中未处方指南推荐的高血压药物 目标1- 2.实施研究综合框架将用于 进行这些采访。目标3包括开发一个经过训练和测试的算法 (from回顾性数据），包括SPRINT和Aim 1-2发现和增强功能 以少数民族为基础。湖城VA医疗中心20号基于场景的模型 （SLCVAMC）PACT供应商将用于确定初始工具的可行性、可用性， 接受度、供应商利益、安全性和满意度。