Partners IN CONTROL: Using Remote MonitorINg teChnology with cOmmuNity healTh woRkers to support hypertensiOn management for Latinx patients

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Latinx adults experience a disproportionate burden of cardiovascular disease in the United States, driven in part by structural barriers to accessing and utilizing care. Latinx patients are at risk for hypertension (HTN), and are less likely to be able to access necessary care to manage this condition. Digital health tools such as remote patient monitoring (RPM) have potential to improve the care of Latinx patients with HTN by enabling more frequent and tailored monitoring of blood pressure, providing additional health information, empowering patients, and enhancing care decision-making without disrupting patients’ daily lives. However, there are significant disparities in the access and use of these digital tools, as well as challenges to equitable and sustainable implementation. To mitigate these disparities, there is urgent need to identify methods to equip and facilitate the implementation of RPM for diverse populations and address social, structural, and digital determinants of health to make RPM care more appropriate for diverse patient needs. Community health workers (CHWs) are specifically trained to address social and structural determinants of health to help patients manage health conditions, provide culturally and contextually competent support, and navigate complex health systems; “tech- enabled” CHWs have potential to be catalysts for improved RPM use for Latinx patients. Our team – comprised of leaders of RPM implementation and infrastructure, CHW training, informatics, digital health, quantitative and qualitative study design, data analytics, and health disparities research – seeks to determine if the addition of RPM-enabled CHWs provided with specific training and EHR support tools can improve HTN control and reduce inequities among Latinx patients with uncontrolled HTN. Specifically, we seek to: 1) develop adapted community health worker remote patient monitoring training modules (“CHW RPM”) and electronic health record support tools (“CHW RPM-EHR") guided by the CFIR model to enhance the management of hypertension in Latinx patients; 2) evaluate the effectiveness of RPM-enabled CHWs compared to standard of care RPM hypertension management on blood pressure reduction among 300 Latinx patients with uncontrolled hypertension; and 3) apply Proctor’s Implementation Outcomes Framework (IOF) to evaluate the implementation of the RPM-enabled CHWs for HTN management, and examine adoption, acceptability, fidelity, cost, sustainability, and equity as mechanisms of implementation effectiveness. The primary outcome will be improvements in HTN management at 12 months. We will utilize a mixed methods approach – including EHR-based data review, patient surveys, in- depth interviews with PCPs, RNS, CHWs, and patients – novel consensus-building, user-centered design and agile development techniques, and theory-driven implementation assessment frameworks to assess the intervention. This research will help inform RPM implementation for our diverse patient population, as well as offer larger insights into to the opportunities and challenges of using CHWs to expand access to RPM to Latinx patients and ultimately improve health equity.