Collaboration to Improve Blood Pressure in the US Black Belt- Addressing the Triple Threat

 描述（由申请人提供）：该提案的中心目标是严格比较两种旨在改善初级保健实践中血压（BP）控制的策略，这些策略为生活在“黑带”中的社会经济地位较低的东南部非洲裔美国人提供服务。黑带位于中风带的中心，中风带是一个长期被认为是美国心血管疾病死亡率最高的地理区域。我们利用越来越多的证据表明，实践促进（PF），一个高度定制的，分阶段的方法，以帮助实践实施流程和结构的变化，可以提高护理质量，提高病人和工作人员的满意度，但有较少的证据表明，它能够改善结果，如BP控制。另一种改善心血管疾病风险因素的方法是更注重关系，并且越来越多的证据表明有效性，包括使用同伴教练。我们和其他人已经证明，同伴教练在黑带社区是有效的，那里对医疗保健系统的不信任是普遍的。利用完善的社区伙伴关系和RE-AIM实施框架，我们的UH 2具体目标是：1。参与农村初级保健实践，高血压（HTN）患者，同伴教练和AL和NC的社区咨询委员会合作完成PF干预和同伴教练干预，两者都旨在改善非裔美国人的BP。2.为试验创建数据系统。我们的具体目标是：3。在一项随机分组、对照的实用实施试验中，在每个诊所招募80名患者和25名非裔美国人不受控制的HTN患者（总计n=2000），以使用2 x 2析因设计比较在UH 2阶段完成的两种多组分、多水平干预措施以及增强的常规护理。我们假设，这两种干预措施将改善BP比加强常规护理，并提供两种干预措施一起将导致更大的改善BP比单独干预。虽然我们的目标是在75%的参与干预患者中控制血压，但该试验旨在检测联合干预和加强常规护理组之间血压控制（主要结局）的差异>15%。次要结果将包括基线和随访之间的组平均血压差异;生活质量;患者满意度;医疗保健利用率;以及提供者和工作人员满意度。这项研究旨在研究性别，年龄，抑郁症和健康素养/算术的差异。目标4。使用旨在促进未来实施的广泛过程数据，包括实践特征、患者特征、干预实施变量和保真度措施，以及焦点小组和与患者、同行教练、促进者、实践工作人员和临床医生的访谈，在整个黑带地区建立干预的可扩展性。我们在基于社区的同伴指导干预方面拥有丰富的经验; PF干预; CVD的健康差异研究;以及参与现实世界实践的大型多地点随机对照试验，确保项目的成功。

 DESCRIPTION (Provided By Applicant): The central objective of this proposal is to rigorously compare two strategies designed to improve blood pressure (BP) control in primary care practices serving rural Southeastern African Americans with low socioeconomic status living in the "Black Belt". The Black Belt is in the heart of the Stroke Belt, a geographic area long recognized to have the highest cardiovascular disease mortality in the US. We draw on the growing evidence that practice facilitation (PF), a highly customized, staged approach to helping practices to implement process and structural changes, can enhance the quality of care and improve patient and staff satisfaction, but there is less evidence on its ability to improve outcomes such as BP control. An alternate approach to improving CVD risk factors that is more relationship-focused and with growing evidence of effectiveness involves the use of peer coaches. We and others have shown that peer coaches are effective in Black Belt communities, where mistrust of the healthcare system is common. Using well-established community-based partnerships and the RE-AIM implementation framework, our UH2 Specific Aims are: 1. Engage rural primary care practices, hypertension (HTN) patients, peer coaches, and Community Advisory Boards in AL and NC to collaboratively finalize a PF intervention and a peer coaching intervention, both designed to improve BP in African Americans. 2. Create the data systems for the trial. Our UH3 Specific Aims are: 3. Enroll 80 practices and 25 African American patients with uncontrolled HTN at each practice (total n=2000) in a cluster-randomized, controlled pragmatic implementation trial to compare the two multi- component, multi-level interventions finalized in the UH2 phase with enhanced usual care using a 2 x 2 factorial design. We hypothesize that both interventions will improve BP more than enhanced usual care, and that both interventions delivered together will result in greater improvements in BP than either intervention alone. While we aim to control BP in 75% of participating intervention patients overall, the trial is designed to detect >15% difference in BP control (primary outcome) between the combined intervention and the enhanced usual care arms. Secondary outcomes will include group mean BP differences between baseline and follow- up; quality of life; patient satisfaction; healthcare utilization; and provider and staff satisfaction. The study is designed to examine differences by sex, age, depression, and health literacy/numeracy. Aim 4. Establish scalability of the intervention throughout the entire Black Belt region using extensive process data intended to facilitate future implementation, including practice characteristics, patient characteristics, intervention implementation variables and fidelity measures, as well as focus groups and interviews with patients, peer coaches, facilitators, practice staff, and clinicians. We have extensive experience with community-based peer coaching interventions; PF interventions; health disparities research in CVD; and large multi-site randomized controlled trials engaging real-world practices, assuring the success of the project.