ACHIEVE P3 - CHD

实现 P3 - CHD

• 批准号: 10437398
• 负责人: Sanjay Rajagopalan
• 金额: $ 87.19万
• 依托单位: WAYNE STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-24 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10437398
• 关键词: Address; Adoption; Awareness; Behavioral; Blood Pressure; Cardiovascular Diseases; Caring; Catchment Area; Cities; Code; Collaborations; Communication; Communities; Community Health; Community Health Aides; Coronary heart disease; Counseling; Detection; Diabetes Mellitus; Diet; Dose; Education; Effectiveness; Enrollment; Evaluation; Geography; Glucose; Glycosylated hemoglobin A; Goals; Great Lakes Region; Guidelines; Health; Health Personnel; Health Services Accessibility; Health Technology; Home; Home Blood Pressure Monitoring; Housing; Hypertension; Individual; Intervention; Interview; Lead; Life; Life Expectancy; Life Style; Life Style Modification; Link; Lipids; Longevity; Low-Density Lipoproteins; Maintenance; Malignant Neoplasms; Managed Care; Measures; Medical; Mental Health; Methods; Modeling; Monitor; Neighborhoods; Nurses; Obesity; Outcome; Participant; Pathway Analysis; Pathway interactions; Patient Care Team; Patients; Pharmacists; Pharmacotherapy; Population; Populations at Risk; Positioning Attribute; Practical, Robust Implementation and Sustainability Model; Precision Health; Prevention; Process; Provider; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Resources; Risk; Risk Assessment; Risk Factors; Screening procedure; Service delivery model; Site; Smoking; Socioeconomic Status; Surveys; Technology; Testing; Trust; United States; Universities; University Hospitals; Urban Health; Visit; Weight; authority; base; black men; black patient; built environment; cardiometabolic risk; cardiometabolism; cardiovascular health; cardiovascular risk factor; care coordination; community organizations; contextual factors; coronary artery calcium; cost; cost effectiveness; effectiveness testing; empowerment; evidence base; experience; health disparity; health inequalities; healthspan; high risk; improved; improved outcome; intervention effect; medication compliance; metropolitan; motivational enhancement therapy; multi-component intervention; multidisciplinary; novel; outreach; personalized approach; personalized screening; point of care; precision medicine; programs; risk perception; scale up; screening; screening program; smoking cessation; social; social health determinants; success; treatment risk; urban area

ABSTRACT The substantial improvement in lifespan and health span in the United States, attributable to improvements in awareness, detection and treatment of risk factors have not translated into Black individuals. Life expectancy among Black males remains recalcitrantly low and comparable to the developing world. Socio-economic status, education, neighborhood, built environment, community context and behavioral factors or social determinants of health (SDoH) account for ~80% of variance in health outcomes and cluster geographically. Strategies to address health inequities in Black individuals must acknowledge and address SDoH. Precision health technologies, access to care coordination and guidance on lifestyle, diet and pharmacotherapy have traditionally been the prerogative of the privileged, but offer value, by virtue of their accuracy and co-benefits of engagement, education and empowerment. The overall hypothesis of PROJECT 3 is that a visionary free precision medicine approach to identify “at-risk” Blacks. and linkage to care using a pragmatic reimbursable HUB-facilitated, community health worker (CHW) led, personalized, adaptable approach to lifestyle and life circumstance (PAL2) intervention, will improve the triple goal of optimal blood pressure, lipids and glucose targets. PAL2 will incorporate proven interventions including CHW care coordination, motivational interviewing, lifestyle coaching, home blood pressure monitoring and importantly will be tunable to address high risk patients (CAC≥100) with a nurse-dietician-pharmacist. We will partner with the Cuyahoga Metropolitan Housing Authority (CMHA), one of the nation’s largest subsidized housing programs and Better Health Partnerships (BHP), a Cleveland based non-profit, that offers a CHW-HUB model of care. Utilizing a Practical Robust Implementation and Sustainability Model (PRISM) framework to address RE-AIM domains (Reach x Efficacy: Adoption, Implementation, Maintenance) and contextual factors, our multi-disciplinary team will test the benefits of a tunable PAL2 intervention to achieve guideline driven targets while exploring contextual factors that may determine the success of our intervention.

抽象的 美国寿命和健康寿命的显着改善归因于 对危险因素的认识、发现和治疗尚未转化为黑人个体的预期寿命。 黑人男性的生育率仍然很低，与发展中国家相当。 地位、教育、邻里、建筑环境、社区背景和行为因素或社会 健康决定因素 (SDoH) 约占健康结果差异的 80%，并且在地理上聚类。 解决黑人健康不平等问题的策略必须承认并解决 SDoH 的精确性。 卫生技术、获得护理协调以及生活方式、饮食和药物治疗的指导已经 传统上是特权的特权，但由于其准确性和共同利益而提供价值 项目 3 的总体假设是有远见的自由。 精准医疗方法来识别“高危”黑人，并使用务实的可报销方式与护理联系起来。 HUB 推动、社区卫生工作者 (CHW) 主导、个性化、适应性强的生活方式和生活方法 环境（PAL2）干预，将改善最佳血压、血脂和血糖的三重目标 PAL2 将纳入经过验证的干预措施，包括 CHW 护理协调、动机访谈、 生活方式指导、家庭血压监测和重要的将进行调整以解决高风险 患者（CAC≥100）与护士-营养师-药剂师合作 我们将与凯霍加大都会医院合作。 住房管理局 (CMHA)，全国最大的补贴住房计划和 Better Health 之一 Partnerships (BHP) 是一家位于克利夫兰的非营利组织，提供实用的 CHW-HUB 护理模式。 用于解决 RE-AIM 领域（Reach 功效：采用、实施、维护）和背景因素，我们的多学科团队将进行测试 可调整的 PAL2 干预措施在探索情境的同时实现指南驱动目标的好处 可能决定我们干预成功的因素。