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.

项目概要 高血压是全球发病率和死亡率的主要危险因素。即使血压轻微升高 (BP) 是有害的，1 期高血压患者面临双重心血管风险。黑人成人 高血压的患病率较高，控制率较差，并且更频繁地对健康造成不良影响。 他们也面临更高的风险，从轻度高血压提前加速进展为更严重的高血压。 在减轻与高血压相关的健康不平等方面进展甚微。以黑人为主的城市 例如底特律，心脏病死亡率几乎是全国平均死亡率的两倍 疾病。越来越多的证据表明，普遍存在的健康负面社会决定因素 (SDoH) 是主要因素 这些不平等的驱动因素，也是黑人高血压患者实现血压控制的关键障碍。核 问题包括获得医疗保健的机会较差以及护理联系系统繁重，特别是在欠发达地区 资源环境、健康教育和识字率低以及护理服务的结构性不足，包括 未能解决导致血压升高并阻碍采用有益的生活环境的一系列问题 生活方式的改变。在 ACHIEVE GREATER 研究中心的项目 1 中，我们提出了一项创新 在未确诊的黑人成年人的早期阶段识别和控制高血压的方法，可能 为终生健康公平带来巨大的好处。使用混合 I 型有效性实施 和准实验设计，我们将利用我们新颖的移动健康联合（MHU）平台来实现 该计划将患有 1 期高血压的低风险黑人成人与非 医生、社区卫生工作者 (CHW) 和药剂师，由个性化、适应性强的人员组成 为期 12 个月的生活方式和生活环境 (PAL2) 干预方法。 PAL2 的核心功能包括 能够从一系列现成的干预措施中进行选择，以解决个人的负面 SDoH 问题， 具有文化敏感性的健康和生活方式教育，以及根据其接受程度随时间推移的适应性， 有效性（家庭血压）和不断变化的患者需求。如果 6 个月后血压仍≥130/80 mm Hg， 将添加药剂师指导的医疗算法，以实现及时的血压控制。计划好处 包括降压效果将在实施阶段（12 个月）和维护阶段（一年）进行评估 2）与医疗联动后。我们的目标是展示项目 1 在 12 点后降低家庭血压的有效性 生活在底特律贫困社区的 500 名轻度 1 期高血压黑人患者的几个月 以达到目标人群。我们还旨在评估项目 1 的保真度和结果，并检查其 成本效益。通过战略性 MHU 外展以及加强协作来改善护理服务 护理，可以有效消除障碍，减轻负面 SDoH 并改善黑人成人的血压控制 高血压。 ACHIEVE GREATER 中心的项目 1 代表了一种新颖且可扩展的模型， 促进美国各地继续面临差距的城市黑人社区的健康公平。