REDUCING DISPARITIES IN HYPERTENSION WITH A PRACTICE-BASED ENHANCED CARE PROGRAM

以实践为基础的加强护理计划减少高血压的差异 主要研究者：Darren A. DeWalt，医学博士，公共卫生硕士 许多种族和族裔群体以及社会经济地位低的个人对 高血压，心血管疾病的患病率较高，与其他群体相比，心血管原因导致的死亡率较高。这些差异的潜在原因已经阐明，但很少有研究调查专门设计的干预措施，以缩小差距和改善结果。我们将采用以社区为基础的参与式研究方法，了解患者和提供者面临的障碍和促进因素，并仔细设计和测试基于实践的，可持续的，增强的高血压护理干预措施。该干预措施将针对患者和实践层面的药物和生活方式管理，旨在缩小BP控制方面的差距。我们将包括来自当地初级保健实践的患者，包括大型社区卫生中心和农村实践。干预措施将包括与非营利呼叫中心Connectinc建立创新伙伴关系，在他们目前关注的工作、就业和福利咨询的基础上增加生活方式和药物依从性指导。虽然我们希望改善每个人的BP控制，但这项研究的重点是缩小白人和非洲裔美国人之间的BP种族差距。我们将使用基于社区的参与式研究方法，从患者和实践的角度来确定关键问题，并邀请患者和实践与研究团队合作设计干预措施。然后，我们将进行一项队列研究，招募600名参与者，以确定该计划的有效性及其减少种族和健康素养状况差异的能力。最后，我们将严格评估实施和维持这种基于实践的干预措施的成本。假设这是一个有效的计划，我们将开始传播的过程，使用质量改进战略的一部分，北卡罗来纳州和国家计划，提高在实践中的表现（IPIP）？一个项目，在7个州实施以国家为基础的基础设施，促进初级保健实践为基础的改进。基于网络的培训将通过共享资源核心互联网资源：培训和资源翻译卓越中心提供。这项研究将为实施以证据为基础的高血压质量改善计划提供信息，以便可持续的护理模式可以帮助减少健康差距。

Reducing Disparities in Hypertension with a Practice-Based Enhanced Care Program Principal Investigator: Darren A. DeWalt, MD, MPH Many racial and ethnic groups and individuals of low socioeconomic status have worse control of hypertension, higher prevalence of cardiovascular disease, and eariier mortality from cardiovascular causes compared to other groups. Potential causes of these disparities have been elucidated, but few studies have investigated interventions specifically designed to narrow the disparity gap and improve outcomes. We will use a community-based participatory research approach to understand the barriers and facilitators faced by both patients and providers and to carefully design and test a practice-based, sustainable, enhanced care intervention for hypertension. The intervention will target medication and lifestyle management at both the patient and practice level, and is designed to narrow disparities in BP control. We will include patients from local primary care practices, including a large community health center and rural practices. The intervention will include an innovative partnership with a nonprofit call center, Connectinc, adding a lifestyle and medication adherence coaching component to their current focus on jobs, employment, and benefits counseling. Although we anticipate improving BP control for everyone, the study focuses on narrowing the racial gap in BP between Whites and African Americans. We will use community-based participatory research approaches to identify the key issues from the patient and practice perspective and invite patients and practices to work with the research team to design the intervention. We will then conduct a cohort study, enrolling 600 participants to determine the effectiveness of the program and its ability to reduce disparities by race and by health literacy status. Lastly, we will rigorously evaluate the costs of implementing and sustaining this practice-based intervention. Assuming it is an effective program, we will begin the process of dissemination using quality improvement strategies as part ofthe North Carolina and national programs for Improving Performance in Practice (IPIP)¿a project in 7 states to implement state-based infrastructure facilitating primary care practice-based improvement. Web based training will be made available through the Shared Resource Core internet resource: Center of Excellence for Training and Resource Translation. This study will inform the implementation of evidence-based hypertension quality improvement programs so that sustainable models of care can exist to help reduce health disparities.