Multi-ethnic Multi-level Strategies and Behavioral Economics to Eliminate Hypertension Disparities in LA County.

项目摘要/摘要 在美国消除种族/民族心血管健康差异不能不解决 高血压循证治疗的差异。在洛杉矶县(LAC)，有 大约有801,000名拉丁裔，266,000名亚裔和244,000名非裔美国人患有高血压，以及 这些人中有一半以上的家庭收入低于联邦贫困水平的200%。在拉丁美洲和加勒比 卫生服务部(DHS)，美国第二大市政卫生系统，患者，临床医生， 健康系统和社区因素导致高血压患病率、控制率、 以及按种族/民族划分的结果。在LAC DHS中导致高血压差异的种族/民族差异 与健康饮食、体力活动、肥胖、降压药物使用、 服药依从性，社区对高血压的认识，以及社区层面的身体和社会 资源。在LAC DHS中，这些差距被广泛认为是解决高血压相关问题的障碍 尽管存在种族/族裔健康差异，但健康生活方式做法和治疗方面的差异依然存在。我们建议 通过利用我们团队在多种族、多层面的专业知识，显著减少LAC和DHS之间的差距 循证战略、社区/利益攸关方参与、公私伙伴关系、执行 科学和行为经济学。我们的建议对拉丁美洲和加勒比地区国土安全部提供高质量、 具有成本效益的护理，我们将重点放在降低高血压相关的高成本上 心脏和肾脏疾病。使用探索、准备、实施、可持续(EPIS)框架， 我们建议对高血压控制进行多层次干预，以完成EPIS的探索/准备 UG3阶段和UG4阶段的实施/维持阶段。与所有人合作 在拉加省国土安全部的51个成人初级保健诊所，我们的目标是：目标1(UG3)：评估多层次(患者，临床医生， 卫生系统领导力和社区)文化菜单的障碍、推动者和偏好- 量身定制的循证实践(EBP)和实施战略，具有既定的有效性 高血压控制。目标2(UG3)：选择并系统地应用行为经济学来设计我们的 患者、临床医生和社区指导的实施战略，以最大限度地提高接受度、接受度和 有效性。目标3(UG4)：在阶梯形楔子中测试我们的实施战略的有效性 使用RE-AIM指导未控制高血压评估的整群随机试验设计 与拉丁美洲和加勒比非少数族裔人口的比较，以及基于证据的做法。

Project Summary/Abstract Eliminating racial/ethnic cardiovascular health disparities in the U.S. cannot be achieved without addressing disparities in evidence-based treatment of hypertension. In Los Angeles County (LAC), there are approximately, 801,000 Latino, 266,000 Asian, and 244,000 African American adults with hypertension, and more than half of these individuals have household income below 200% of the federal poverty level. In the LAC Department of Health Services (DHS), the second largest municipal health system in the US, patient, clinician, healthy system, and community factors contribute to substantial disparities in hypertension prevalence, control, and outcomes by race/ethnicity. Racial/ethnic gaps that contribute to hypertension disparities in LAC DHS relate to differences in healthy eating, physical activity, obesity, antihypertensive pharmacotherapy use, medication adherence, community awareness of hypertension, and community-level physical and social resources. These gaps are widely recognized in LAC DHS as barriers to addressing hypertension-related racial/ethnic health disparities, yet differences in healthy lifestyle practices and treatment persist. We propose to significantly reduce disparities in in LAC DHS by leveraging our team's expertise in multi-ethnic, multi-level evidence-based strategies, community/stakeholder engagement, public-private partnerships, implementation science, and behavioral economics. Our proposal is sensitive to LAC DHS' mission of providing high quality, cost-effective care, which we address with an ancillary focus on reducing the high cost of hypertension-related heart and kidney disease. Using the Exploration, Preparation, Implementation, Sustainment (EPIS) framework, we propose a multi-level intervention for hypertension control that will complete EPIS Exploration/Preparation stages in the UG3 phase and the Implementation/Sustainment stages in the UG4 phase. In partnership with all 51 adult primary care clinics in LAC DHS, our aims are: Aim 1 (UG3): Assess multi-level (patient, clinician, health system leadership, and community) barriers to, facilitators of, and preferences for a menu of culturally- tailored evidence-based practices (EBPs) and implementation strategies with established efficacy for hypertension control. Aim 2 (UG3): Select and systematically apply behavioral economics to the design of our patient-, clinician-, and community-directed implementation strategies to maximize acceptability, uptake, and effectiveness. Aim 3 (UG4): Test the effectiveness of our implementation strategies in a stepped-wedge cluster randomized trial design using RE-AIM to guide assessment of uncontrolled hypertension, disparities in comparison to non-minority LAC populations, and evidence-based practices.