Actions to Decrease Disparities in Risk and Engage in Shared Support for Blood Pressure Control (ADDRESS-BP) in Blacks

减少黑人风险差异并共同支持血压控制 (ADDRESS-BP) 的行动

• 批准号: 10674292
• 负责人: NADIA S ISLAM
• 金额: $ 22.27万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-10 至 2023-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10674292
• 关键词: Address; Adherence; Adoption; Behavioral; Black Populations; Black race; Blood Pressure; Blood Pressure Monitors; Caring; Case Manager; Clinic; Clinical; Clinical effectiveness; Communication; Communities; Community Health Aides; Community Integration; Consolidated Framework for Implementation Research; Counseling; Data; Decision Making; Effectiveness; Evaluation; Evidence based intervention; Exhibits; Goals; Guidelines; Health; Health system; Home; Home Blood Pressure Monitoring; Hypertension; Infrastructure; Insurance Carriers; Intervention; Level of Evidence; Medicaid; Methods; Minority Groups; Modeling; Monitor; Names; New York City; Nurses; Patients; Pharmaceutical Preparations; Phase; Physicians; Primary Health Care; Process; Proctor framework; Provider; Public Health; Resources; Risk; Site; Social support; System; Testing; Titrations; Training; Training Support; Transportation; Vulnerable Populations; Work; black patient; blood pressure control; care coordination; community barrier; community based participatory research; community clinic; community engagement; cost effectiveness; design; dissemination research; evidence base; experience; food insecurity; housing instability; hypertension control; hypertension treatment; implementation evaluation; implementation fidelity; implementation outcomes; implementation process; implementation protocol; implementation research; implementation strategy; improved; minority patient; mortality disparity; pilot test; primary care setting; primary outcome; provider factors; racial disparity; recruit; routine care; secondary outcome; sound; telemonitoring; treatment as usual

PROJECT SUMMARY/ABSTRACT: Hypertension (HTN) control in Blacks is sub-optimal due to barriers at the patient, health systems, provider, and community-levels of care. Although the efficacy of nurse case management (NCM) and home blood pressure monitoring (HBPM) is well-proven; these strategies do not address community-level barriers (unstable housing, transportation) to adequate HTN control, thus limiting their impact in Blacks. Integration of community health worker (CHWs) into primary care to help patients navigate community resources is effective for HTN control in patients experiencing community-level barriers. Despite their efficacy, implementation of these multi-level evidence-based interventions (NCM, HBPM, and use of CHWs) into routine care in real world primary care practices, where a majority of minority patients receive care, is suboptimal. This proposal harnesses practice facilitation (PF)- a theoretically sound and sustainable implementation strategy to evaluate the implementation of NCM, HBPM, and CHWs delivered as an integrated community-clinic linkage model [Practice support And Community Engagement (PACE)] to address patient-, physician-, health system-, and community-level barriers to HTN control in Blacks. We will test the implementation of PACE across a network of 20 primary practices within NYU Langone Health in NYC, in partnership with an established Community-Clinic-Academic Advisory Board and HealthFirst (NYC's largest Medicaid payer). Practice facilitators will assist practices to integrate NCM and HBPM into the clinic workflow for 6 months, after which the patients' BP control status are re-evaluated; and for those who remain uncontrolled, the facilitators will assist practices to develop processes for the addition of a CHW to the care team to help patients navigate community resources and address community-level barriers to optimal HTN control. NCM comprises home BP telemonitoring, behavioral counseling, and medication adjustment/titration by trained Nurses. Trained CHWs work in partnership with Nurses to enhance care coordination, and provide health coaching and bi-directional referrals between the practices and community resources. We will conduct the proposed study in two phases: 1) a UG3 phase that will use principles of Community-Based Participatory Research and the Consolidated Framework of Implementation Research to develop a context-specific PF strategy and; 2) a UH3 implementation phase that will use Proctor's Implementation Outcomes Framework to evaluate, in a stepped-wedge cluster RCT of 20 primary care practices in 500 Black patients with uncontrolled HTN, the effect of the PF strategy on clinical and cost-effectiveness of PACE. We will also examine adoption and implementation fidelity as potential mechanisms that may explain the impact of PF on BP control. Primary outcome is BP control from baseline to 18 months. Secondary outcome is cost-effectiveness of PACE. The study's findings will provide a practical and sustainable system that harnesses existing clinical and community resources to build capacity for primary care practices to manage HTN control in minority populations.

项目摘要/摘要：黑人高血压（HTN）的控制是次优的