Designing a Remote Monitoring Intervention for Value & Equity in Hypertension (DRIVE-HTN)

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PROJECT SUMMARY This is an application for a Career Development Award for Dr. Elaine Khoong, an Assistant Professor at the University of California San Francisco, whose career goal is to be an embedded health system researcher that applies informatics to conduct interventional implementation research in safety net systems to reduce disparities in cardiovascular disease. This award will provide her with the training and research experience to: (1) design a home blood pressure monitoring program tailored for safety net patients and clinicians; (2) pilot the program to assess implementation and preliminary effectiveness outcomes; and (3) evaluate the cost of the intervention. To facilitate successful completion of these activities, Dr. Khoong has assembled an ideal mentoring team comprised of primary mentor, Dr. Urmimala Sarkar, an expert in implementing digital health solutions to improve chronic disease management in safety net systems and three co-mentors: Dr. Courtney Lyles, an implementation scientist with expertise in human-centered design and innovation implementation in safety net systems; Dr. Kirsten Bibbins-Domingo, an expert in cardiovascular epidemiology, health disparities, and modeling impact of interventions on cardiovascular outcomes; and Dr. Dhruv Kazi, a cardiologist, health economist, and expert in cost-effectiveness analysis of cardiovascular interventions in low-resourced settings. Safety-net health systems, which disproportionately care for low-income or minority populations, play a pivotal role in achieving national hypertension control and disparities goals. Therefore, it is essential to develop and test pragmatic solutions that can be used by both patients and clinicians in these systems. Dr. Khoong will build on findings from previous work that shows (a) usability barriers to adoption of digital tools in low-income or limited health literate populations and (b) challenges to implementing innovations in safety net systems when workflows and infrastructure are not considered. In Aim 1, Dr. Khoong will employ human-centered design techniques to design a home blood pressure monitoring program for use in safety net systems. Dr. Khoong will lead and evaluate a pilot implementation of the intervention in two urban, safety net clinics within the safety net system in San Francisco where Dr. Khoong practices as a general internist (Aim 2). The evaluation will include implementation outcomes, preliminary effectiveness outcomes, and a cost evaluation (Aim 3), which will provide the foundation and preliminary data to design a larger implementation-effectiveness trial of the home blood pressure monitoring program, which can be assessed in an R01 proposal. Through a focused program of mentored training and coursework, the candidate will gain skills in: (1) human-centered design; (2) design, implementation, and evaluation of interventions through embedded research models; and (3) cost-effectiveness analysis. These skills will facilitate Dr. Khoong’s transition to independence by uniquely positioning her to address patient-, clinician-, and system-level barriers to adoption and implementation of evidence-based practices to improve cardiovascular outcomes in safety net patients.