Race/ethnic differences in guideline recommended hypertension medications in VHA

VHA 指南推荐高血压药物的种族/民族差异

• 批准号: 10186551
• 负责人: April F Mohanty
• 金额: --
• 依托单位: VA SALT LAKE CITY HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-02-01 至 2023-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10186551
• 关键词: Address; Adult; Age; Algorithms; Black race; Blood Pressure; Body mass index; Cardiovascular Diseases; Cardiovascular system; Caring; Cessation of life; Chronic; Chronic Kidney Failure; Cities; Clinical Trials; Confidence Intervals; Consolidated Framework for Implementation Research; Data; Development; Diabetes Mellitus; Diagnosis; Diastolic blood pressure; Ensure; Epidemiologist; Ethnic Origin; Event; Fellowship; Female; Foundations; Future; Goals; Guidelines; Health Services; Health Services Administration; Health Services Research; Healthcare; Healthcare Systems; Heart; Heart failure; Hispanics; Historically Black Colleges and Universities; Hypertension; Incidence; Inequality; Informatics; Intervention; Intervention Trial; Interview; Joints; Lead; Life; Medical Informatics; Medical center; Methods; Minority; Minority Groups; Modeling; Myocardial Infarction; Natural Language Processing; Outcome; Patients; Pharmaceutical Preparations; Plant Roots; Population; Practice Management; Prevalence; Provider; Publishing; Race; Randomized Controlled Trials; Recording of previous events; Reporting; Research; Research Personnel; Research Training; Retrospective cohort study; Risk Factors; Safety; Scientist; Services; Site; Sodium Chloride; Stroke; Telephone Interviews; Testing; Time; Training; Training Programs; Treatment Protocols; Treatment outcome; United States; United States Department of Veterans Affairs; United States National Institutes of Health; Veterans; Veterans Health Administration; active duty; acute coronary syndrome; base; blood pressure intervention; blood pressure regulation; cardiovascular disorder prevention; cardiovascular disorder risk; career; ethnic difference; ethnic minority population; evidence base; follow-up; hazard; health disparity; health inequalities; high risk; hypertension control; hypertension treatment; improved; interest; male; military veteran; minority scientist; mortality; patient oriented; racial and ethnic; racial difference; racial disparity; racial minority; satisfaction; sex; tool; usability

Among Veterans, hypertension is the most common chronic condition with a prevalence of 37% and can lead to stroke, myocardial infarction, chronic kidney disease, and heart failure. Among blacks, hypertension occurs earlier in life, is more prevalent and severe, and is less likely to be controlled. While control of hypertension has significantly improved over recent years in the Veterans Affairs (VA), from 46% in 2000 to 76% in 2010, disparities persist among blacks, and reasons are not well understood. The Joint National Committee (JNC) publishes guidelines on evidence-based medications for hypertension treatment. However, controversy remains regarding the target blood pressure (BP) to achieve with therapy. The recently published Systolic Blood Pressure Intervention Trial (SPRINT), a landmark clinical trial, is anticipated to lead to changes in hypertension practices for patients with increased cardiovascular disease risk and without a history of diabetes. Investigators reported a reduction of systolic BP to <120 mm Hg (vs < 140 mm Hg) was associated with a lower incidence of cardiovascular-events, - mortality, and all-cause mortality for both black and nonblack patients. The extent to which systolic BP control of <120 mm Hg is achieved in VA is unknown. Special focus is needed for the VA group at highest risk for uncontrolled BP, black Veterans. This group is expected to grow at least 3% from 11% of Veterans in 2014 to 14% by 2034. The goals of this project are: Aim 1. To examine, one year following Veterans’ incident hypertension diagnosis, patient level predictors of (1) use of guideline-recommended medications and (2) BP control among Veterans and to describe how the effect of these predictors varies by race; Aim 2. To identify provider and facility level predictors of use of guideline-recommended medications and BP control among Veterans with incident hypertension and to describe how the effect of these predictors varies by race using mixed-methods; and Aim 3. To develop and pilot test a provider/team focused informatics strategy to facilitate hypertension control with enhanced features for racial minority Veterans. Aims 1-2 involve a longitudinal retrospective cohort study of black and white Veterans from VA facilities nationwide with incident hypertension 2007-2012 and examining outcomes of (1) prescriptions for JNC7 guideline-recommended medications and (2) controlled hypertension 1-year after incident hypertension diagnosis. Using regression models, patient- (Aim 1), provider- and facility-level (Aim 2) variables will be identified that are predictors for not receiving of guideline-recommended medications for hypertension and/or lack of BP control at 1-year of follow-up. Aims 1-2 further examine how these predictors vary by race. The qualitative analysis for Aim 2 will include chart review using natural language processing methods and a total of 36 telephone interviews with Patient Aligned Care Team (PACT) providers from 4 VA facilities (identified from Aim 1 and Aim 2) to ascertain reasons for not prescribing guideline-recommended hypertension medications among patients identified from Aims 1-2.The Consolidated Framework of Implementation Research will be used to conduct these interviews. Aim 3 includes the development of a trained and tested algorithm (from retrospective data) that incorporates SPRINT and Aim 1-2 findings and enhanced features for racial minorities based. A scenario based mockup with 20 Salt Lake City VA Medical Center (SLCVAMC) PACT providers will be used to determine initial tool feasibility, usability, acceptance, provider interest, safety, and satisfaction.

在退伍军人中，高血压是最常见的慢性病，​​患病率为 37% 并可导致中风、心肌梗塞、慢性肾病和心力衰竭。 黑人中，高血压发生得更早，更普遍、更严重，并且不太可能 近年来，高血压的控制已得到显着改善。 退伍军人事务部 (VA) 从 2000 年的 46% 上升到 2010 年的 76%，黑人之间的差距仍然存在， 原因尚不清楚。国家联合委员会 (JNC) 发布了相关指南。 然而，高血压治疗的循证药物仍然存在争议。 关于治疗要达到的目标血压 (BP)。 收缩压干预试验（SPRINT）是一项具有里程碑意义的临床试验，预计将 导致心血管疾病增加患者的高血压治疗方法发生变化 研究人员报告，收缩压降低至<120。 毫米汞柱（相对于 < 140 毫米汞柱）与较低的心血管事件发生率相关，- 黑人和非黑人患者的死亡率和全因死亡率。 VA 中能否实现收缩压控制<120 mm Hg 尚不清楚，需要特别关注。 退伍军人事务部的血压不受控制的风险最高，黑人退伍军人预计这一群体将会增长。 至少 3%，从 2014 年的 11% 增加到 2034 年的 14%。该项目的目标是： 目标 1。 检查退伍军人高血压诊断一年后的患者水平 (1) 使用指南推荐的药物和 (2) 血压控制的预测因素 退伍军人并描述这些预测因素的影响如何因种族而异 目标 2. 确定 指南推荐药物和血压使用的提供者和设施水平预测因素 控制患有高血压的退伍军人并描述这些措施的效果如何 使用混合方法的预测因子因种族而异；目标 3. 开发并试点测试 以提供者/团队为中心的信息学策略，通过增强的方法促进高血压控制 目标 1-2 涉及少数族裔退伍军人的特征，涉及纵向回顾性队列研究。 2007-2012 年全国退伍军人事务部机构中患有高血压的黑人和白人退伍军人的比例 并检查 (1) JNC7 指南推荐药物的处方结果和 (2) 高血压诊断后 1 年内高血压得到控制。 将确定模型、患者（目标 1）、提供者和设施级别（目标 2）变量 未接受指南推荐的高血压药物和/或缺乏药物的预测因素 目标 1-2 进一步研究这些预测因素如何变化。 目标 2 的定性分析将包括使用自然语言进行图表审查。 处理方法以及与患者协调护理团队进行的总共 36 次电话访谈 (PACT) 4 个 VA 设施（根据目标 1 和目标 2 确定）的提供者，以确定原因 未在确定的患者中开出指南推荐的高血压药物 目标 1-2。实施研究综合框架将用于 目标 3 包括开发经过训练和测试的算法。 （来自回顾性数据）结合了 SPRINT 和 Aim 1-2 的发现和增强功能 基于 20 盐湖城 VA 医疗中心的基于场景的模型。 (SLCVAMC) PACT 提供商将用于确定初始工具的可行性、可用性、 接受度、提供者兴趣、安全性和满意度。