Hypertension Management in Minority and Low-income Populations

描述（由申请人提供）：该提案的总体目标是在安全网环境中制定、调整、实施和评估高血压控制干预措施，以照顾患有慢性肾病（CKD）和糖尿病等复杂共病的少数族裔患者。 Bibbins-Domingo 博士是 U54 合作资助的联合 PI，该资助评估临床实施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服务系统中提供持续血压控制的文化定制饮食干预措施；这些干预措施将构成本文研究的适应性干预措施的基础。该提案旨在实现以下目标：目标 1. 将 U54 开发的高血压干预措施调整、实施和评估，以适应加州资源有限的安全网环境；目标 2. 使用新的微观模拟计算机模型来确定有效高血压干预措施的基本要素，并使用已建立的基于人群的计算机模型（CVD 政策模型）来预测此类干预措施对健康差异的人口影响。该提案将增强 Bibbins-Domingo 博士的职业目标，即追求实施科学方法方面的教学和体验式培训，培养多学科研究人员团队（包括肾病专家、心脏病专家和实施科学家），能够开发有效的预防干预措施，以便在资源有限的环境中照顾复杂的患者，并将她之前的计算机建模工作整合到新的基于临床的干预措施的分析中。她将通过来自广泛学科的受训人员的指导研究来开展此处描述的工作。 Bibbins- Domingo 博士是 旧金山总医院的加州大学旧金山分校弱势群体中心以及临床和转化科学研究所 K 学者项目的主任，该项目为初级教师提供职业发展奖的指导。她在指导学员和初级教师方面有着长期的记录，其中包括亚专家（即肾病专家、心脏病专家、内分泌专家）和几位来自 URM 背景的人员。该提案将发展新的科学，同时为初级研究人员提供丰富的培训环境，并促进比宾斯-多明戈博士自身的职业发展。

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.