Blood Pressure-Visit Intensification for Successful Improvement of Treatment

描述(由申请人提供)：在高血压患者中控制血压(BP)可降低心血管发病率和死亡率。然而，在与高血压相关的办公室就诊中，血压仅被控制在56%。黑人对BP的较差控制是心血管疾病种族差异的关键因素。第七届高血压诊断、预防和治疗联合国家委员会(JNC VII)处理高血压管理问题。虽然临床医生对JNC VII指南的采纳与BP治疗和药物选择的启动相关的情况稳步改善，但临床医生在很大程度上未能执行JNC关于无控制BP患者每月就诊的建议。这一转换差距代表着改善次优BP控制的潜在机会，同时也解决了BP控制中的差异。这项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进BP控制。我们建议使用在临床主任网络内实施的理论上知情和基于证据的多模式质量改进干预来实现这些目标，临床主任网络是一个由联邦合格卫生中心(FQHC)组成的基于实践的研究网络。我们的中心假设是，针对与这一建议相关的临床医生的意识、态度、技能和常规将提高患者的就诊频率。我们的第二个假设是，提高就诊频率将改善BP控制。我们建议通过一项务实的随机试验来严格检验这些重要的假设，该试验在参与的FQHC中使用逐步楔入的干预措施。我们将通过从参与实践的电子医疗记录中提取数据来评估访问频率和BP。我们的具体目标是：目标1：实施JNC关于血压失控的高血压患者每月就诊的建议，使用理论上知情的、有经验的、多模式的QI干预。目的2：通过实施月访查，改善血压控制，缩小血压差距。目标3：评估干预的潜在调解人和调解人。研究结果对有效实施这一指导方针的最佳战略具有国家影响。如果成功，实施每月访问是改善BP控制的一种简单可行的手段，并有可能解决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探视的随机试验，以改善BP。我们的团队包括高血压、务实试验、FQHC研究和临床医生与患者交流方面的专家，非常适合进行这项研究，并通过正式和非正式的网络传播研究结果。

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.