Actions to Decrease Disparities in Risk and Engage in Shared Support for Blood Pressure Control (ADDRESS-BP) in Blacks

项目摘要/摘要 这份申请是对乔伊斯·贾姆菲博士的多样性补充的请求。这份副刊旨在 通过最近资助的行动提供指导、培训和高级研究经验 减少风险差异，共同支持BP控制(Address-BP)赠款(# HL151310)，重点放在可伸缩性上，这是实现科学的期望结果。确定因素 (障碍和促进者)影响多层次循证干预(MEBI)可扩展性的因素是 对于弥合实施科学中证据与实践的差距至关重要。此外，至关重要的是 理解干预、环境(背景)、促进之间的复杂交互作用 战略，以及利益相关者的持续参与，以促进在各种情况下的可扩展性。目前， 没有扩展MEBI的全面运营流程、路线图或逻辑模型；然而， 必须使干预措施在人口层面形成规模，以确保重大公共卫生 冲击力。作为这项多样性补充的一部分，这项研究旨在评估 通过利益相关者的积极参与，在母公司赠款中增加PACE干预的可扩展性，以 以确定阻碍该MEBI可伸缩性的障碍和促进者。实践支持和社区 参与(PACE)使用实践促进(PF)作为可持续实施战略，以 评估三种MEBI，包括护士病历管理(NCM)、家庭血压监测 (HBPM)和社区卫生工作者(CHW)，作为综合社区-诊所联系提供 纽约模特(NYC)。尽管这个MEBI拥有成功的核心组件 在临床环境中执行，如何在其他城市和/或农村环境中扩展PACE还需要进一步 研究。可扩展性，这是一项重要的实施成果，必须进行评估，以确保 将PACE转换为其他临床和社区服务系统。实施科学 框架--促进卫生服务研究行动(PARiHS)--以及世卫组织/扩展网 扩大规模建议-将指导评估。这两个框架的使用通过混合- 方法(有关键利益攸关方的半结构调查和重点小组)和实践能力 来自父母赠款的目标2的数据将允许评估证据之间的相互关系， 背景和促进；并为以下方面的逻辑模型和业务流程的发展提供信息 维持PACE的规模，这是父母拨款改善人口的合理下一步 在最初研究之外的其他高负担社区的健康状况。 具体地说，在这一多样性补充中，Gyamfi博士的目标是完成以下研究和 培训目标：具体目标1：研究：分目标1A：评估背景、障碍和 使用PARIHS实施PACE血压控制干预的促进者 纽约市20家初级保健诊所的框架(环境扫描)。子目标1B：评估 利用世卫组织/扩展网络扩大次级目标1A的PACE干预的可扩展性的潜力 建议。SubAim 1C：开发强大的业务流程和逻辑模型，以指导 横向和纵向扩展PACE，并通过利益相关者评估模型的可行性 反馈。 具体目标2：职业发展：参与课程、培训和指导，以 通过参加以下课程和课程，增加实施研究方面的知识 培训：1)传播和实施研究与卫生培训机构(TIDIRH)， 2)设计干预措施以改变组织行为；3)定性和混合方法 研究，4)实施研究的生物统计学/统计建模，5)赠款撰写。 具体目标3：大刀阔斧：扩大执行研究的知识范围 通过参加会议、起草出版物和实现这种多样性的最终目标 补充经验，即提交早期调查员(ESI)K或R(例如，R21) 对国家卫生研究院的应用重点是中试测试和提炼MEBI放大的逻辑模型 补充资助期结束。

PROJECT SUMMARY / ABSTRACT This application is a request for a diversity supplement for Dr. Joyce Gyamfi. The supplement aims to provide mentorship, training, and advance research experience via the recently funded Actions to Decrease Disparities in Risk and Engage in Shared Support for BP Control (ADDRESS-BP) grant (# HL151310), with a focus on scalability, a desired outcome in implementation science. Identifying factors (barriers and facilitators) that impact scalability of multi-level evidence-based interventions (MEBI) is critical to closing the evidence to practice gap in implementation science. Moreover, it is essential to understand the complex interaction between the intervention, environment (context), the facilitation strategy, and continuous stakeholder engagement to promote scalability in various contexts. Currently, there is no comprehensive operational process, roadmap, or logic model for scaling up MEBI; however, it is essential to bring interventions to scale at the population level to ensure significant public health impact. The research proposed as part of this diversity supplement aims to assess the potential scalability of the PACE intervention in the parent grant through active stakeholder engagement, in order to identify barriers and facilitators to the scalability of this MEBI. The Practice support And Community Engagement (PACE) uses practice facilitation (PF) as a sustainable implementation strategy to evaluate three MEBI which include nurse case management (NCM), home blood pressure monitoring (HBPM), and community health workers (CHW), delivered as an integrated community-clinic linkage model in New York City (NYC). Although this MEBI has the core components to be successfully executed in clinical settings, how PACE will be scaled in other urban and/or rural settings needs further research. Scalability, which is an essential implementation outcome must be assessed to ensure the translation of PACE to other clinical and community service systems. The implementation science framework - Promoting Action on Research in Health Services (PARiHS) - and the WHO/ExpandNet Scale -up recommendations- will guide the assessment. The use of the two frameworks via mixed- methodology (semi-structured surveys and focus groups with key stakeholders) and practice capacity data from Aim 2 of the parent grant will allow assessment of the interrelationship between evidence, context, and facilitation; and inform development of a logic model and an operational process for sustaining scale-up of PACE, which is a rational next step for the parent grant to improve population health in other high-burden communities beyond the initial study. Specifically in this diversity supplement, Dr. Gyamfi aims to accomplish the following research and training aims: SPECIFIC AIM 1: RESEARCH: SubAim 1A: Evaluate the context, barriers, and facilitators to implementation of the PACE blood pressure control intervention using the PARIHS framework (Environmental scan) at 20 primary care practices in New York City. SubAim 1B: Assess the potential for scalability of the PACE intervention in SubAim 1A using WHO/ExpandNet Scale-up recommendations. SubAim 1C: Develop robust operational process and logic model that will guide horizontal and vertical scale-up of PACE and assess the feasibility of the model via stakeholder feedback. SPECIFIC AIM 2: CAREER DEVELOPMENT: Engage in coursework, training, and mentorship to increase knowledge in implementation research by participating in the following coursework and training: 1) Training Institute for Dissemination and Implementation in Research and Health (TIDIRH), 2) Designing Interventions to Change Organizational Behavior; 3) Qualitative and Mixed Methods Research, 4) Biostatistics /Statistical Modeling for Implementation Research, 5) Grant writing. SPECIFIC AIM 3: GRANTSMANSHIP: Broaden the scope of knowledge in implementation research by attending conferences, drafting publications, and achieving the ultimate goal of this diversity supplement experience, which is to submit an Early Stage Investigator (ESI) K or R (e.g., R21) application to NIH focused on pilot testing and refining the logic model for scale-up of MEBI before the end of the supplement funding period.