Hypertension Improvement Project (HIP)

描述（由申请人提供）：高血压影响25%的美国成年人口，仍然是心血管疾病的主要原因。只有25%的高血压患者达到目标血压（BP）.高血压改善项目（HIP）是一项随机对照试验，将测试医生持续质量改进（CQI）干预和患者行为干预对血压控制的单独和综合影响。医生将从杜克初级保健研究联盟的实践中挑选出来，为低收入和少数民族人口服务。实践被随机分配到医生（MD）干预或MD控制条件。在这些实践中，所有MD均接受相同的干预，其患者被单独随机分配至患者干预或患者常规护理条件。MD干预包括三个主要要素：在线培训模块;用于临床的评估和治疗算法;以及CQI程序，包括临床性能指标评估和对医生遵守指南的反馈。将收集18个月的性能数据，并每3个月向MD提供一次反馈。来自这些实践的患者（约50%为女性，至少40%为非洲裔美国人，90%为低收入）将被随机分配至患者干预或常规护理。患者干预包括6个月的行为干预，旨在改变生活方式以降低血压并坚持服用处方BP药物。在干预结束时和一年后（即，随机化后6个月和18个月）。主要结局是每个治疗组中6个月时血压得到充分控制的患者比例。血压控制由JNC-6目标定义（大多数患者的收缩压< 140和舒张压< 90 mmHg;心血管或肾脏疾病或糖尿病患者的目标较低）。其他结果包括18个月时的血压控制，医生对国家指南的遵守，以及患者对生活方式建议和药物治疗方案的遵守。还将进行成本分析。该研究将在10个实践中招募400名患者（约20名医生），并将有80%的把握度检测到主要结局的效应量为0.3。HIP研究将测试改善高血压控制的实际干预措施，这些措施可以广泛实施并降低CVD风险。

DESCRIPTION (provided by applicant): Hypertension affects 25 % of the adult US population overall and remains a leading cause of cardiovascular disease. Only 25 % of people with hypertension are at goal blood pressure (BP). The Hypertension Improvement Project (HIP) is a randomized, controlled trial that will test the separate and combined effects on BP control of a continuous quality improvement (CQI) intervention for physicians and a behavioral intervention for patients. Physicians will be selected from practices in the Duke Primary Care Research Consortium that serve low income and minority populations. Practices are randomly assigned to the physician (MD) intervention or to the MD control condition. Within these practices, all MDs receive the same intervention, and their patients are individually randomized to the patient intervention or to the patient usual care condition. The MD intervention consists of three main elements: on-line training modules; an evaluation and treatment algorithm for use in the clinic; and a CQI procedure involving assessment of Clinical Performance Measures and feedback to physicians on their adherence to guidelines. The performance data will be collected for 18 months and feedback will be provided to MDs every 3 months. Patients from these practices (approximately 50% women, at least 40% African American, 90% low income) will be randomly assigned to the patient intervention or usual care. The patient intervention consists of a 6-month behavioral intervention aimed at lifestyle changes to lower BP and adherence to prescribed BP medications. BP and other follow-up measurements are performed at the end of the intervention and a year later (i.e., at 6 and 18 months postrandomization). The primary outcome is the proportion of patients in each treatment group that have adequate BP control at 6 months. BP control is defined by JNC-6 goals (systolic BP < 140 and diastolic BP < 90 mmHg for most patients; lower goals for patients with cardiovascular or renal disease or diabetes). Other outcomes include BP control at 18 months, physician adherence to national guidelines, and patient adherence to lifestyle recommendations and medication regimens. A cost analysis will also be done. The study will enroll 400 patients in 10 practices (approximately 20 physicians), and will have 80% power to detect an effect size of 0.3 for the primary outcome. The HIP study will test practical interventions for improving hypertension control that can be broadly implemented and reduce CVD risk.