Shake, Rattle and Roll

摇动、发出嘎嘎声和滚动

• 批准号: 9143806
• 负责人: MAI N NGUYEN-HUYNH
• 金额: $ 51.81万
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至 2019-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9143806
• 关键词: Accounting; Address; Adherence; Adult; African American; Age; Antihypertensive Agents; Area; Blood Pressure; Blood Vessels; California; Cardiovascular Diseases; Cardiovascular system; Cessation of life; Clinic; Clinical; Clinical Research; Communities; Computerized Medical Record; Counseling; DASH diet; Data; Diet; Enrollment; Event; Goals; Habits; Health Maintenance Organizations; Healthcare; High Prevalence; Housing; Hypertension; Incidence; Individual; Inpatients; Intervention; Ischemic Stroke; Laboratories; Leadership; Life Style; Link; Managed Care; Names; Not Hispanic or Latino; Outcome; Outpatients; Patients; Pharmacotherapy; Pharmacy facility; Population; Population Heterogeneity; Positioning Attribute; Prevalence; Preventive Intervention; Primary Health Care; Primary Prevention; Protocols documentation; Provider; Race; Radiology Specialty; Randomized; Randomized Controlled Trials; Records; Registries; Research; Research Infrastructure; Risk Factors; Role; Services; Sodium Chloride; Sodium-Restricted Diet; Stroke; Surveys; System; Telephone; Time; age group; blood pressure regulation; care systems; disparity reduction; health care availability; health care service utilization; health disparity; high risk; hypertension control; improved; innovation; member; post stroke; pragmatic trial; prevent; primary outcome; programs; racial disparity; racial diversity; retention rate; therapy design; three-arm trial; treatment as usual; young adult

In the U.S., blacks have a higher prevalence of hypertension (HTN) and a higher Incidence of ischemic Stroke compared to whites. Less than 50% of adults with hypertension have controlled BP. Racial disparities exist with regard to the proportions of those who are treated and treated successfully, especially between black and white. In Kaiser Permanente Northern California (KPNC), a setting where all members have similar access to healthcare, black patients with ischemic stroke and HTN still had poorer BP control at 6 months post-stroke when compared to other races despite equal healthcare utilization, antihypertensive prescription and adherence. It has been suggested that greater difficulty in controlling BP and lifestyle differences may account for this difference. The goal of this pragmatic study is to improve HTN control rate in blacks and to reduce racial disparity in HTN control. To accomplish this, we propose to perform a cluster randomized controlled trial at the primary care provider (PCP) level and including 191 PCPs within KPNC East Bay Service Area with more than 45,000 patients in the HTN registry of which approximately 15,000 are black. We will randomize all PCP patient panels to a three-arm trial to receiving either 1) usual care; or 2) culturally tailored diet and lifestyle coaching; or 3) an intensified BP management protocol with pharmacotherapy. The "Shake, Rattle and Roll" trial is named for: 1) "shake" the salt habit; 2) "rattle" the intensity of current BP management; and 3) design the interventions with the goal of being able to adapt and "roll" them out to community clinics outside of a managed care system. Primary research question: whether a primary prevention intervention of either diet and lifestyle coaching or an intensive pharmacotherapy protocol is more effective than usual care in improving rates of HTN control in blacks and thereby reducing disparities between black and white. Primary aim: By implementing either intervention, we will reduce the disparity in hypertension control rates between blacks and whites by 4% at 1 year post-study enrollment. Hypothesis: Among blacks with HTN, a diet/lifestyle coaching intervention or an intensified BP management protocol will result in an increase in HTN control rate compared to usual care. Primary outcome: the proportion of patients with sustained BP control at 1 year post-study enrollment.

在美国，黑人高血压 (HTN) 患病率较高，缺血性心脏病发生率较高 与白人相比中风。不到 50% 的成人高血压患者血压得到控制。种族 接受治疗和治疗成功的比例存在差异，特别是 黑与白之间。在北加州凯撒医疗机构 (KPNC)，所有成员都可以 尽管获得医疗保健的机会相似，但患有缺血性中风和高血压的黑人患者的血压控制仍然较差 中风后 6 个月，与其他种族相比，尽管医疗保健利用率相同，但抗高血压药物 处方和依从性。有人认为，控制血压和生活方式的难度更大 差异可能是造成这种差异的原因。 这项务实研究的目标是提高黑人的高血压控制率并减少黑人的种族差异 HTN 控制。为了实现这一目标，我们建议在初级研究中进行整群随机对照试验 护理提供者 (PCP) 级别，包括 KPNC 东湾服务区内的 191 名 PCP，拥有超过 HTN 登记册中有 45,000 名患者，其中约 15,000 名是黑人。我们将对所有 PCP 进行随机分组 参加三臂试验的患者小组接受以下任一治疗： 1) 常规护理；或 2) 因文化而异的饮食和生活方式 辅导；或 3) 采用药物治疗强化血压管理方案。 “摇动、摇晃和滚动”试验的命名是为了： 1）“摇动”盐的习惯； 2）“嘎嘎”电流强度 血压管理； 3）设计干预措施，目标是能够适应并“推出”它们 管理式医疗系统之外的社区诊所。 主要研究问题：饮食和生活方式指导是否是一级预防干预措施 或者强化药物治疗方案在提高高血压控制率方面比常规护理更有效 黑人，从而减少黑人和白人之间的差异。 主要目标：通过实施任一干预措施，我们将缩小高血压控制率的差异 研究后一年，黑人和白人之间的差异为 4%。 假设：在患有高血压的黑人中，饮食/生活方式指导干预或强化血压管理 与常规护理相比，该方案将导致 HTN 控制率提高。 主要结局：研究入组后一年血压持续控制的患者比例。