Hypertension Improvement Project(HIP)

描述(由申请人提供)：高血压影响了美国25%的成年人口，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联合影响。医生将从杜克初级保健研究联盟的诊所中挑选，这些诊所服务于低收入和少数族裔人口。实践被随机分配给医生(MD)干预或MD控制条件。在这些实践中，所有的MD都接受相同的干预，他们的患者被单独随机分配到患者干预或患者通常的护理条件下。MD干预包括三个主要要素：在线培训模块；临床使用的评估和治疗算法；以及CQI程序，其中包括对临床表现衡量标准的评估和对医生遵守指南的反馈。绩效数据将收集18个月，并每3个月向MD提供反馈。来自这些实践的患者(大约50%是女性，至少40%是非裔美国人，90%是低收入者)将被随机分配到患者干预或常规护理中。患者干预包括为期6个月的行为干预，旨在改变生活方式以降低血压，并坚持服用处方的血压药物。在干预结束和一年后(即干预后6个月和18个月)进行BP和其他随访测量。主要结果是每个治疗组的患者在6个月时有足够的血压控制的比例。血压控制由JNC-6目标(大多数患者的收缩压140和舒张压90毫米汞柱；较低的心血管或肾脏疾病或糖尿病患者的目标)定义。其他结果包括18个月后血压控制，医生遵守国家指南，患者遵守生活方式建议和药物治疗方案。还将进行成本分析。这项研究将招募400名患者参加10项实践(约20名医生)，并将有80%的力量来检测主要结果的效应大小为0.3。HIP研究将测试可广泛实施的改善高血压控制和降低心血管疾病风险的实际干预措施。

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.