ACHIEVE P1 - HTN

实现 P1 - HTN

• 批准号: 10662512
• 负责人: Robert Daniel Brook
• 金额: $ 57.77万
• 依托单位: WAYNE STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-24 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10662512
• 关键词: Acceleration; Accounting; Address; Adoption; Adult; Advocate; Algorithms; American; Atherosclerosis; Black race; Blood Pressure; COVID-19; Cardiovascular Diseases; Caring; Chronic Kidney Failure; Cities; Communities; Community Health Aides; Cost Analysis; Coupled; Data; Disease; Disparity; Early treatment; Education; Effectiveness; Employment; Environment; Event; Evidence based practice; Failure; Familiarity; Goals; Great Lakes Region; Guidelines; Health; Health Services Accessibility; Health education; Heart; Heart Diseases; Heart failure; High Prevalence; Home; Hybrids; Hypertension; Improve Access; Individual; Inequity; Intervention; Length; Life; Life Style; Link; Maintenance; Medical; Methods; Mobile Health Units; Modeling; Morbidity - disease rate; Outcome; Patients; Persons; Pharmaceutical Preparations; Pharmacists; Phase; Practical Robust Implementation and Sustainability Model; Prevention; Process; Quasi-experiment; Research; Resources; Risk; Risk Factors; Role; Target Populations; Testing; Time; United States; Urban Community; Vaccinated; black patient; blood pressure control; blood pressure elevation; blood pressure reduction; burden of illness; cardiometabolism; cardiovascular disorder risk; cardiovascular risk factor; care delivery; care systems; collaborative care; coronavirus disease; cost effectiveness; evidence base; health care availability; health disparity; health equity; health inequalities; health literacy; hypertension control; hypertensives; implementation/effectiveness; improved; innovation; mHealth; mortality; neighborhood disadvantage; novel; outreach; prevent; primary outcome; programs; racial disparity; social health determinants; social vulnerability; success

PROJECT SUMMARY Hypertension is the leading risk factor for global morbidity and mortality. Even mild elevations in blood pressure (BP) are harmful whereby individuals with stage 1 hypertension are at double cardiovascular risk. Black adults suffer from a higher prevalence, worse control rates, and more frequent adverse health effects from high BP. They are also at heightened risk for an earlier accelerated progression from mild to more severe hypertension. Little progress has been made in mitigating health inequities related to high BP. Predominantly Black cities such as Detroit disproportionately suffer from nearly twice the national average mortality rate due to heart disease. Mounting evidence shows that pervasive negative social determinants of heath (SDoH) are major drivers of these inequities and represent a critical barrier to achieving BP control in Black hypertensives. Core issues include poor access to healthcare and a burdensome system for care linkage especially in under- resourced settings, low health education and literacy, and structural inadequacies in care delivery including a failure to address the spectrum of life circumstances that elevate BP and hinder the adoption of salutary lifestyle changes. In PROJECT 1 of the ACHIEVE GREATER research center, we propose an innovative approach to identify and control hypertension at its earliest stages in undiagnosed Black adults, potentially yielding an enormous benefit towards lifetime health equity. Using a hybrid type I effectiveness-implementation and quasi-experimental design, we will leverage our novel mobile health unite (MHU) platform to implement a program that links low risk Black adults with stage 1 hypertension to collaborative care delivered by non- physicians, community health workers (CHWs) and pharmacists, consisting of a personalized, adaptable approach to lifestyle and life circumstance (PAL2) intervention for 12-months. Core features of PAL2 include the ability to choose from a menu of readily available interventions that address individual negative SDoH, culturally sensitive health and lifestyle education, and adaptability over time according to its acceptance, effectiveness (home BP), and evolving patient needs. If BP remains ≥130/80 mm Hg after 6 months, a pharmacist-directed medical treatment algorithm will be added to achieve timely BP control. Program benefits including BP-lowering will be assessed during the implementation (12-months) and maintenance phases (year 2) after linkage to medical care. We aim to show the effectiveness of project 1 to lower home BP after 12 months in 500 Black patients with mild stage 1 hypertension living in disadvantaged communities in Detroit and to reach the target population. We also aim to evaluate the fidelity and outcomes of project 1 and examine its cost effectiveness. Improving care access by strategic MHU outreach, coupled with enhanced collaborative care, can effectively remove barriers, mitigate negative SDoH and improve BP control in Black adults with hypertension. PROJECT 1 of the ACHIEVE GREATER center represents a novel and scalable model to advance health equity in urban Black communities across the United States that continue to face disparities.

项目摘要 高血压是全球发病率和死亡率的主要危险因素。即使是血压的轻度升高 （BP）有害，其中1阶段高血压患者具有双重心血管风险。黑人成年人 患病率较高，控制率较差，而高BP的健康影响更大。 它们还处于从轻度到更严重的高血压中较早加速进展的风险。 在减轻与BP有关的健康不平等方面，几乎没有取得进展。主要是黑城市 例如底特律不成比例地遭受几乎是全国平均死亡率而遭受的两倍 疾病。越来越多 这些不平等的驱动因素，代表了在黑色高血压中实现BP控制的关键障碍。核 问题包括无法获得医疗保健和用于护理联系的朴素系统，尤其是在不足的情况下 资源丰富的环境，低健康教育和识字以及护理交付的结构性不足，包括 未能解决生活环境的范围，以提高BP并阻碍采用有益的人 生活方式改变。在成就大研究中心的项目1中，我们提出了创新的 在未诊断的黑人成年人中最早识别和控制高血压的方法，可能 为终身健康公平带来巨大的好处。使用I型I型有效性实施 和准实验设计，我们将利用新颖的移动健康部门（MHU）平台实施 将低风险黑人与1期高血压联系起来的计划与非 - 医师，社区卫生工作者（CHW）和药剂师，由个性化，适应性 生活方式和生活环境的方法（PAL2）干预了12个月。 PAL2的核心功能包括 能够从可用的可用干预措施菜单中进行选择，这些干预措施解决各个负面SDOH， 对文化敏感的健康和生活方式教育以及随着时间的推移的适应性， 有效性（家庭BP），并进化患者需求。如果BP在6个月后保持≥130/80 mm Hg，则 将添加由药剂师定向的医学治疗算法，以实现及时的BP控制。程序的好处 在实施期间（12个月）和维护阶段（年份 2）与医疗保健联系后。我们的目的是展示项目1在12之后降低家庭BP的有效性 500名轻度1阶段高血压的黑人患者生活在底特律的灾难群落和 到达目标人群。我们还旨在评估项目1的忠诚度和结果并检查其 成本效益。通过战略MHU宣传改善护理访问，再加上增强的协作 护理，可以有效消除障碍，减轻负面SDOH并改善黑人成年人的BP控制 高血压。成就更大中心的项目1代表一个新颖且可扩展的模型 在美国各地的城市黑人社区中提高卫生公平，继续面临分配。