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

合作改善美国黑带血压——应对三重威胁

• 批准号: 10191671
• 负责人: Andrea L Cherrington
• 金额: $ 11.6万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-31 至 2022-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10191671
• 关键词: Address; Adult; Affect; African American; Age; Alabama; Algorithms; Behavior Therapy; Blood Pressure; Cardiovascular Diseases; Caring; Characteristics; Client satisfaction; Cluster randomized trial; Collaborations; Communities; Custom; Data; Diabetes Mellitus; Effectiveness; Electronic Health Record; Enrollment; Ethnic Origin; Feedback; Focus Groups; Future; Geographic Locations; Goals; Group Interviews; Health; Healthcare Systems; Heart; Heart Diseases; Hypertension; Individual; Information Systems; Intervention; Intervention Trial; Maryland; Measures; Medication Management; Mental Depression; Minority; North Carolina; Outcome; Patients; Phase; Poverty; Practice based research; Primary Health Care; Process; Protocols documentation; Provider; Quality of Care; Quality of life; Randomized; Randomized Controlled Trials; Registries; Reporting; Research; Resources; Rest; Risk Factors; Risk Reduction; Rural; Sex Differences; Site; Speed; Stretching; Stroke; Stroke Belt; Structure; System; Testing; Texas; United States Agency for Healthcare Research and Quality; Universities; agricultural region; base; blood pressure medication; blood pressure regulation; cardiovascular disorder prevention; cardiovascular disorder risk; design; evidence base; experience; follow-up; health care service utilization; health disparity; health literacy; high risk; hypertension control; implementation trial; improved; improved outcome; low socioeconomic status; mathematical ability; mortality; peer coaching; primary outcome; rural residence; satisfaction; secondary outcome; success; treatment as usual; trial comparing; usual care arm

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.

该提案的核心目的是严格比较旨在改善血液的两种策略 在基层医疗惯例中的压力（BP）控制服务，为较低的东南非裔美国人提供服务 社会经济地位生活在“黑带”中。黑带位于卒中腰带的中心，地理 长期以来，在美国，长期以来的心血管疾病死亡率最高。我们借鉴了成长 证据表明，实践设施（PF）是一种高度定制的，分阶段的方法来帮助实践 实施过程和结构变化可以提高护理质量并改善患者和员工 满意度，但是关于它改善BP控制等结果的能力的证据较少。另一种 改善更多以关系为中心的CVD风险因素的方法，并有越来越多的证据表明 有效性涉及使用同伴教练。我们和其他人表明，同伴教练有效 黑带社区，医疗保健系统的刻痕很常见。使用良好的 基于社区的合作伙伴关系和Re-AIM实施框架，我们的UH2具体目标是：1。 参与农村初级保健实践，高血压（HTN）患者，同伴教练和社区咨询 AL和NC的董事会合作最终确定了PF干预措施和同行教练干预措施 旨在改善非裔美国人的BP。 2。为试验创建数据系统。我们的UH3特定目标 为：3。在每种练习中招生80种练习和25名非裔美国人患者（总数） n = 2000）在群集随机，受控的务实实施试验中，以比较两个多元 组件，使用2 x 2在UH2阶段最终确定了UH2阶段的多层干预措施 阶乘设计。我们假设，这两种干预措施都将改善BP远远超过了增强常规护理，并且 两种干预措施共同提供将导致BP的改善，而不是两种干预措施 独自的。虽然我们的目标是控制75％的参与干预患者的BP，但该试验旨在 检测> 15％的BP对照差异（主要结果）和增强 通常的护理臂。次级结果将包括基线和后续结果之间的组平均BP差异 向上;生活质量；患者满意度；医疗保健利用；提供者和员工满意度。这项研究是 旨在检查性别，年龄，抑郁和健康素养/算术的差异。目标4。建立 使用旨在 促进未来的实施，包括实践特征，患者特征，干预 实施变量和忠诚度措施以及焦点小组和与患者的访谈，同伴 教练，主持人，实践人员和临床医生。我们在基于社区的同伴方面有丰富的经验 教练干预措施； PF干预措施； CVD的健康差异研究；和大型多站点随机 对照试验吸引了现实世界实践，并确保该项目的成功。

项目成果

The Key Driver Implementation Scale (KDIS) for practice facilitators: Psychometric testing in the "Southeastern collaboration to improve blood pressure control" trial.

• DOI: 10.1371/journal.pone.0272816
• 发表时间: 2022
• 期刊: PloS one
• 影响因子: 3.7

Implementing practice facilitation in research: how facilitators spend their time guiding practices to improve blood pressure control.

• DOI: 10.1186/s43058-023-00470-y
• 发表时间: 2023-07-31
• 期刊: Implementation science communications

Greater Social Functioning Associated With Lower Depressive Symptomatology Among Black Belt African Americans Enrolled in the Southeastern Collaboration to Improve Blood Pressure Control Study.

参加东南部合作改善血压控制研究的黑带非裔美国人的更大的社会功能与较低的抑郁症状相关。

• DOI: 10.4088/pcc.21m02988
• 发表时间: 2022
• 期刊: The primary care companion for CNS disorders
• 作者: Finch,AnthonyJ;Ringel,JoannaBryan;Dargar,Savira;Halladay,Jacqueline;Cene,Crystal;Cherrington,Andrea;Cummings,Doyle;Safford,MonikaM
• 通讯作者: Safford,MonikaM