Facilitation of Team-based Care to Improve HTN Management and Outcomes

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Project Summary Hypertension (HTN) is the most prevalent modifiable risk factor for cardiovascular disease (CVD) among U.S. adults. There are well-established guidelines for managing HTN, yet HTN remains undertreated. There are a number of reasons for inadequate adoption of HTN care guidelines, including skepticism about guideline recommendations, perceptions that patients are non-adherent to medications, and lack of systems to facilitate best practices in HTN management. Team based care (TBC) has the potential to overcome these barriers. TBC is the provision of health services by at least two health providers who work collaboratively to improve chronic disease management through enhancements in quality improvement (QI) infrastructure to support care coordination, population management, self-management support, medication adherence and continuity of care. Numerous studies have demonstrated that TBC is an evidence-based strategy for improving blood pressure (BP) management and control. Despite the effectiveness of TBC, primary care practices experience significant barriers to implementing TBC care processes. This is particularly true for small-medium size independent primary care practices (SIPs), an understudied group of practices that represent the majority of outpatient care delivery but which often lack the resources and local expertise to implement care processes consistent with TBC. External practice facilitation (PF), a strategy to support implementation of evidence-based models of care into routine practice, may mitigate barriers to adoption of TBC in SIPs. Yet, there is a dearth of literature on the effect of PF on adoption of TBC in general and specifically in SIPs. The objective of this study is to compare the effectiveness of PF on the adoption of core TBC components, centered on improving BP management and outcomes in SIPs, to usual care. In this study, a PF implementation strategy will be developed through mixed methods formative assessment and input from a representative stakeholder advisory committee. This PF strategy will then be evaluated in a stepped wedge cluster randomized control trial in 90 independent primary care practices in New York City where the effect of PF on adoption of TBC (primary outcome) and blood pressure control (secondary outcome) will be compared against usual care. Given the public health burden that elevated BP presents, implementation of TBC as an evidence-based practice to improve BP control has great potential to improve CVD outcomes. This study will provide much- needed guidance on how to optimize adoption and sustainability of TBC in independent primary care setting to realize the potential of improved HTN management and addresses current gaps in prior research.