Insights for Community Health

描述(申请人提供)：高血压(HTN)是美国黑人的头号死因，并导致心血管疾病(CV)发病率和死亡率的种族差异。心血管发病率和死亡率不成比例的主要原因是血压(BP)控制不佳。通过一级和二级预防努力改善BP控制，可显著降低黑人的心血管风险，并可通过针对自我管理行为的循证干预实现。然而，尽管这些干预措施被证明有效，但几乎没有证据表明它们传播到以社区为基础的社区 设置。地方卫生部门面临的挑战是重新设计这些基于证据的方法，以便在典型社区组织可用的资源和技能水平上可持续地发挥作用。在纽约市，卫生和精神卫生部(DOHMH)开发了Keep on Track(Kot)，这是一项由志愿者运营的社区计划，旨在通过血压监测会议、简短的咨询和健康教育来降低老年人的血压。在DOHMH的技术和物质支持下，信仰组织和老年中心的非专业卫生工作者(LHW)为社区成员测量血压读数，将他们的读数记录在索引卡上，并提供咨询以支持生活方式的改变和医疗保健的获得。对Kot的评估显示，在没有失去后续行动的成员中，BP有望减少。然而，管理该计划的LHW报告了管理跟踪卡数量的困难，并表示对更有效的信息管理工具感兴趣。为了解决这一限制，本应用程序的主要目标是评估实施个人健康记录(PHR)系统的可行性，该系统是定制的，使纽约市两个以黑人为主的教堂的LHW能够使用Congregational Dashboard跟踪BP和健康行为的个人和总体变化。第二个目标是评估PHR系统对血压、体力活动、体重减轻、水果和蔬菜摄入量以及从基线到9个月的初级保健医生就诊次数的变化的影响。主要目标和次要目标的结果将在个人和教会一级进行评估。将在整个项目期间进行一次形成性评价，突出必要的系统修改和方案改进。将使用混合方法RE-AIM框架的修订版进行进程评估。BP将使用经过验证的自动BP监测仪进行评估。健康行为将通过有效的自我报告测量进行评估；体重减轻将根据基线和9个月之间的体重差异进行估计。长期目标是创建卫生信息技术系统，以建设社区组织实施可持续和可推广的循证疾病预防和健康促进模式的能力，允许在全国范围内更广泛地翻译拯救生命的干预措施，并为从诊所到社区环境的护理协调奠定基础。

DESCRIPTION (provided by applicant): Hypertension (HTN) is the number one cause of death for Blacks in the United States and drives the racial disparity in cardiovascular (CV) morbidity and mortality. A major reason for the disproportionate CV morbidity and mortality is poor blood pressure (BP) control. Improving BP control through both primary and secondary prevention efforts leads to significant CV risk reduction in Blacks and can be achieved through evidence-based interventions targeting self-management behaviors. Yet, despite the proven efficacy of these interventions, there is little evidence of their dissemination to community-based settings. The challenge for local health departments is to redesign these evidence-based approaches to function sustainably at the level of resources and skills available in typical community-based organizations. In NYC, the Department of Health and Mental Hygiene (DOHMH) has developed Keep on Track (KOT), a volunteer-run, community program that aims to lower BP of older adults through BP monitoring sessions, brief counseling and health education. With technical and material support from DOHMH, lay health workers (LHW) at faith- based organizations and senior centers take BP readings for community members, record their readings on index cards and provide counseling to support lifestyle change and health care access. An evaluation of KOT has demonstrated promising BP reductions among members who were not lost to follow-up. However, LHWs administrating the program report difficulties managing the volume of tracking cards, and express interest in more effective tools for information management. To address this limitation, the primary aim of this application is to assess the feasibility of implementing a Personal Health Record (PHR) system customized to enable LHWs in two predominately Black churches in NYC to track individual and aggregate changes in BP and health behaviors using a Congregational Dashboard. The secondary aims are to evaluate the effect of the PHR system on changes in BP, physical activity, weight loss, fruit and vegetable intake, and number of visits to a primary care physician from baseline to 9 months. Outcomes for the primary and secondary aims will be assessed at the individual and church-level. A formative evaluation will be conducted throughout the project period, highlighting necessary system modifications and programmatic refinements. A process evaluation will be conducted with a modified version of the mixed-methods RE-AIM framework. BP will be assessed with a validated automated BP monitor. Health behaviors will be assessed with validated self-report measures; weight loss will be estimated as the difference in weight between baseline and 9 months. The long-term goal is to create health IT systems that could build the capacity of community-based organizations to implement evidence-based models of disease prevention and health promotion that are sustainable and generalizable, allowing for broader translation of life-saving interventions across the nation, and laying a foundation for coordination of care from the clinic to the community setting.