Reach Out 2: Randomized Clinical Trial of Emergency Department-Initiated Hypertension Mobile Health Intervention Connecting Multiple HealthSystems

高血压是心血管疾病最重要的可改变的危险因素。美国黑人有 高血压患病率最高，血压（BP）控制率最低 美国的一个组织，导致心血管疾病的差异。低收入美国人也 高血压的负担。为了实现健康公平，高血压的新方法 需要利用安全网保健系统的管理，以帮助得不到充分服务的人口。 解决高血压流行病的一种方法是识别和治疗未确诊、未治疗的人， 或者患有治疗不足的高血压的人--他们已经从医疗保健系统的裂缝中掉了出来。我们 在Reach Out 1（R 01 MD 011516）中进行了这项研究，这是一项移动的健康（mHealth）8臂析因试验， 从安全网ED招募的患者。在约500名黑人中年参与者中，43%是 失业; 21%没有高血压的诊断; 51%没有服用抗高血压药 22%的人没有初级保健提供者。总体而言，收缩压下降了9.2 mmHg（95%）， CI -12.2至-6.3），治疗组间无差异。Reach Out 1成功注册 高血压、医疗服务不足的人群进行移动健康干预尽管有很大的减少， BP总体而言，由于缺乏对照组，Reach Out mHealth干预措施的有效性尚不确定。 Reach Out 2建议在一个随机开放的盲法中测试Reach Out 1中最有前途的组成部分， 终点（PROBE）对照试验。伸出2，继续我们的工作与相同的安全网艾德和联邦 合格的保健中心。在《伸出援手2》中，我们将比较常规护理和6个月的自我监测 血压（SMBP）监测与定制的反馈和促进初级保健预约， 运输常规护理组将收到指示，在艾德后与初级保健提供者进行随访 放电6个月后，干预参与者将进入长期的延长治疗期。 SMBP监测。为了将我们的发现置于情境中，我们将使用基于慢性疾病病原体的模拟模型 估计如果实施Reach Out 2，心肌梗死、中风和痴呆的减少情况 在全美的安全网急诊室里我们提案的首要目标是确定一个低技术含量的 在从安全网艾德招募的患者中，移动健康干预将比常规护理更能降低血压， 了解这种干预的潜在国家影响。因为安全网ED是锚 医疗服务不足的高血压人群的护理机构，移动健康策略 在这里发起的活动具有减少心血管不平等的巨大潜力。为了达到这一潜力，证据- 必须确定降低血压的基础干预措施（目标1），评估长期参与（目标2）， 了解其影响（目标3）。

Hypertension is the most important modifiable risk factor for cardiovascular disease. Black Americans have the highest prevalence of hypertension and the lowest rates of blood pressure (BP) control of any racial or ethnic group in the U.S., contributing to cardiovascular disease disparities. Low-income Americans are also disproportionally burdened by hypertension. To achieve health equity, new approaches to hypertension management leveraging safety-net healthcare systems to reach underserved populations are needed. One approach to addressing the hypertension epidemic is to identify and treat people undiagnosed, untreated, or with undertreated hypertension - people who have fallen through the cracks in the healthcare system. We did this in Reach Out 1 (R01MD011516), a mobile health (mHealth) 8-arm factorial trial of hypertensive patients recruited from a safety-net ED. Among the ~500 majority Black, mid-life participants, 43% were unemployed; 21% did not carry a diagnosis of hypertension; 51% were not taking antihypertensive medications, and 22% did not have a primary care provider. Overall, systolic BP declined by 9.2 mmHg (95% CI -12.2 to - 6.3) after 6 months, without differences across treatment arms. Reach Out 1 successfully enrolled a hypertensive, medically underserved population into a mHealth intervention. Despite a very large reduction in BP overall, the efficacy of the Reach Out mHealth intervention is uncertain, given the lack of a control group. Reach Out 2 proposes to test the most promising components of Reach Out 1 in a randomized open, blinded- endpoint (PROBE) controlled trial. Reach Out 2, continues our work with the same safety-net ED and Federally Qualified Health Centers. In Reach Out 2, we will compare usual care, to 6-months of prompted self-monitored blood pressure (SMBP) monitoring with tailored feedback and facilitated primary care appointment and transportation. The usual care group will receive instructions to follow up with a primary care provider after ED discharge. After 6 months, the intervention participants will enter an extended treatment period of long-term SMBP monitoring. To contextualize our findings, we will use our chronic disease agent-based simulation model to estimate the reduction in myocardial infarction, stroke, and dementia if Reach Out 2 were to be implemented in safety-net EDs across the US. The overarching goal of our proposal is to determine whether a low-tech mHealth intervention will reduce BP more than usual care among patients recruited from a safety-net ED and to understand the potential national impact of such an intervention. Because safety-net EDs are anchor institutions that care for large populations of medically underserved hypertensive people, mHealth strategies initiated here have tremendous potential to reduce cardiovascular inequities. To reach this potential, evidence- based interventions to reduce BP must be identified (aim 1), long-term engagement evaluated (aim 2), and their impact understood (aim 3).