Blood Pressure-Visit Intensification for Successful Improvement of Treatment

描述（由申请人提供）：摘要高血压患者的血压（BP）控制可降低心血管疾病的发病率和死亡率。然而，只有56%的高血压相关办公室就诊的血压得到控制。黑人血压控制较差是心血管疾病种族差异的关键因素。第七届全国高血压诊断、预防和治疗联合委员会（JNC VII）负责高血压管理。虽然临床医生采用JNC VII指南的情况在开始BP治疗和药物选择方面得到了稳步改善，但临床医生在很大程度上未能实施JNC建议，即对血压不受控制的患者进行每月访视。这种翻译差距代表了一个潜在的机会，以改善次优BP控制，同时也解决BP控制的差异。本研究项目的主要目的是改善临床医生对血压不受控制的高血压患者每月就诊的JNC指南的执行情况。我们的次要目标是改善BP控制。我们建议实现这些目标，使用理论上知情和循证的多模态质量改进干预实施的临床主任网络，基于实践的研究网络的联邦合格的卫生中心（CIMHCs）。我们的中心假设是，针对临床医生的意识，态度，技能和惯例相关的这一建议将提高患者的访问频率。我们的次要假设是，提高就诊频率将改善血压控制。我们建议通过一项实用的随机试验来严格检验这些重要的假设，该试验在参与的CNOHC中使用阶梯式楔形分阶段干预。我们将通过从参与实践的电子病历中提取数据来评估访视频率和BP。 我们的具体目标是：目标1：实施JNC建议，使用理论上知情的、经验基础的多模式QI干预，对血压不受控制的高血压患者进行每月访视。 目的2：通过实施每月访视，改善血压控制并减少血压差异。 目的3：评估干预的潜在中介者和调节者。研究结果对有效实施本指南的最佳战略具有国家意义。如果成功的话，实施每月访视是一种简单可行的方法，可以改善BP控制，并可能解决BP控制中的种族差异。据我们所知，该项目将是第一个实施每月访视以改善BP的随机试验。我们的团队包括高血压、务实试验、CIMHC研究和临床医生与患者沟通方面的专家，非常适合开展这项研究，并通过正式和非正式网络传播研究结果。

DESCRIPTION (provided by applicant): Abstract Blood pressure (BP) control among hypertensive patients reduces cardiovascular morbidity and mortality. Yet, BP is controlled at only 56% of hypertension-related office visits. Worse control of BP among Blacks is a key contributor to racial disparities in cardiovascular disease. The Seventh Joint National Committee on the Diagnosis, Prevention and Treatment of Hypertension (JNC VII) address hypertension management. While clinician adoption of JNC VII guidelines has steadily improved relevant to initiation of BP treatment and medication selection, clinicians have largely failed to implement the JNC recommendation for monthly visits for patients with uncontrolled BP. This translational gap represents a potential opportunity to improve suboptimal BP control while also addressing disparities in BP control. The primary aim of this research project is to improve clinician implementation of the JNC guideline for monthly visits for hypertensive patients with uncontrolled BP. Our secondary aim is improved BP control. We propose to accomplish these aims using a theoretically informed and evidence-based multimodal quality improvement intervention implemented within the Clinical Directors Network, a practice based research network of federally qualified health centers (FQHCs). Our central hypothesis is that targeting clinician awareness, attitudes, skills and routines relevant to this recommendation will improve patient visit frequency. Our secondary hypothesis is that improving visit frequency will improve BP control. We propose to rigorously test these important hypotheses through a pragmatic randomized trial that uses a stepped wedge phase-in of the intervention in participating FQHCs. We will assess visit frequency and BP through abstraction of data from electronic medical records of participating practices. Our specific aims are: Aim 1: To implement the JNC recommendation for monthly visits for hypertensive patients with uncontrolled BP using a theoretically-informed, empirically grounded, multimodal QI intervention. Aim 2: To improve BP control and reduce disparity in BP through implementation of monthly visits. Aim 3: To assess potential mediators and moderators of the intervention. Findings have national implications for best strategies for effective implementation of this guideline. If successful, implementation of monthly visits represents a simple and feasible means for improving BP control, and potentially, for addressing racial disparities in BP control. To our knowledge, this project will be the first randomized trial of implementation of monthly visits to improve BP. Our team, which includes experts in hypertension, pragmatic trials, FQHC research, and clinician-patient communication, is well suited to undertake this study and disseminate findings through formal and informal networks.