Actions to Decrease Disparities in Risk and Engage in Shared Support for Blood Pressure Control (ADDRESS-BP) in Blacks

减少黑人风险差异并共同支持血压控制 (ADDRESS-BP) 的行动

基本信息

批准号：
10470504
负责人：
NADIA S ISLAM
金额：
$ 9.61万
依托单位：
NEW YORK UNIVERSITY SCHOOL OF MEDICINE
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-09-10 至 2023-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10470504
关键词：
Address Adherence Adoption Behavioral Blood Pressure Blood Pressure Monitors Caring Case Manager Clinic Clinical Clinical effectiveness Communication Communities Community Health Aides Community Integration Consolidated Framework for Implementation Research Counseling Data Decision Making Effectiveness Evaluation Evidence based intervention Exhibits Goals Guidelines Health Health system Home Home Blood Pressure Monitoring Hypertension Infrastructure Insurance Carriers Intervention Level of Evidence Medicaid Methods Minority Minority Groups Modeling Monitor Names New York City Nurses Patients Pharmaceutical Preparations Phase Physicians Primary Health Care Process Provider Public Health Resources Risk Site Social support System Testing Titrations Training Training Support Transportation Vulnerable Populations Work black patient blood pressure regulation care coordination community based participatory research community clinic community engagement cost effectiveness design dissemination research evidence base experience food insecurity housing instability hypertension control hypertension treatment implementation fidelity implementation outcomes implementation process implementation protocol implementation research implementation strategy improved mortality disparity primary care setting primary outcome provider factors racial disparity recruit routine care secondary outcome sound telemonitoring treatment as usual

项目摘要

PROJECT SUMMARY/ABSTRACT: Hypertension (HTN) control in Blacks is sub-optimal due to barriers at the patient, health systems, provider, and community-levels of care. Although the efficacy of nurse case management (NCM) and home blood pressure monitoring (HBPM) is well-proven; these strategies do not address community-level barriers (unstable housing, transportation) to adequate HTN control, thus limiting their impact in Blacks. Integration of community health worker (CHWs) into primary care to help patients navigate community resources is effective for HTN control in patients experiencing community-level barriers. Despite their efficacy, implementation of these multi-level evidence-based interventions (NCM, HBPM, and use of CHWs) into routine care in real world primary care practices, where a majority of minority patients receive care, is suboptimal. This proposal harnesses practice facilitation (PF)- a theoretically sound and sustainable implementation strategy to evaluate the implementation of NCM, HBPM, and CHWs delivered as an integrated community-clinic linkage model [Practice support And Community Engagement (PACE)] to address patient-, physician-, health system-, and community-level barriers to HTN control in Blacks. We will test the implementation of PACE across a network of 20 primary practices within NYU Langone Health in NYC, in partnership with an established Community-Clinic-Academic Advisory Board and HealthFirst (NYC's largest Medicaid payer). Practice facilitators will assist practices to integrate NCM and HBPM into the clinic workflow for 6 months, after which the patients' BP control status are re-evaluated; and for those who remain uncontrolled, the facilitators will assist practices to develop processes for the addition of a CHW to the care team to help patients navigate community resources and address community-level barriers to optimal HTN control. NCM comprises home BP telemonitoring, behavioral counseling, and medication adjustment/titration by trained Nurses. Trained CHWs work in partnership with Nurses to enhance care coordination, and provide health coaching and bi-directional referrals between the practices and community resources. We will conduct the proposed study in two phases: 1) a UG3 phase that will use principles of Community-Based Participatory Research and the Consolidated Framework of Implementation Research to develop a context-specific PF strategy and; 2) a UH3 implementation phase that will use Proctor's Implementation Outcomes Framework to evaluate, in a stepped-wedge cluster RCT of 20 primary care practices in 500 Black patients with uncontrolled HTN, the effect of the PF strategy on clinical and cost-effectiveness of PACE. We will also examine adoption and implementation fidelity as potential mechanisms that may explain the impact of PF on BP control. Primary outcome is BP control from baseline to 18 months. Secondary outcome is cost-effectiveness of PACE. The study's findings will provide a practical and sustainable system that harnesses existing clinical and community resources to build capacity for primary care practices to manage HTN control in minority populations.

项目摘要/摘要：由于存在障碍，黑人的高血压 (HTN) 控制效果欠佳。患者、卫生系统、提供者和社区各级的护理。虽然护士案例的功效管理（NCM）和家庭血压监测（HBPM）已得到充分证明；这些策略不解决社区层面的障碍（不稳定的住房、交通），以充分控制 HTN，从而限制他们对黑人的影响。将社区卫生工作者 (CHW) 纳入初级保健以帮助患者导航社区资源对于遇到社区障碍的患者的高血压控制有效。尽管这些多层次循证干预措施（NCM、HBPM 和使用社区卫生工作者）纳入现实世界初级保健实践中的常规护理，其中大多数少数族裔患者接受护理，效果欠佳。该提案利用了实践促进（PF）——一种理论上合理且可行的方法。评估 NCM、HBPM 和 CHW 实施情况的可持续实施战略综合社区-诊所联系模型[实践支持和社区参与（PACE）] 解决黑人高血压控制中患者、医生、卫生系统和社区层面的障碍。我们将在 NYU Langone Health 内的 20 个主要诊所网络中测试 PACE 的实施情况纽约市与已建立的社区-诊所-学术咨询委员会和 HealthFirst（纽约市的最大的医疗补助付款人）。实践促进者将协助实践将 NCM 和 HBPM 整合到诊所中 6个月的工作流程，之后重新评估患者的血压控制状态；对于那些留下来的人如果不受控制，协调员将协助实践制定在护理中添加社区卫生工作者的流程团队帮助患者利用社区资源并解决社区层面的最佳 HTN 障碍控制。 NCM 包括家庭血压远程监测、行为咨询和药物调整/滴定由训练有素的护士。经过培训的社区卫生工作者与护士合作，加强护理协调，并提供健康指导以及实践和社区资源之间的双向转介。我们将进行拟议的研究分两个阶段：1）UG3 阶段将使用基于社区的参与原则研究和实施研究综合框架，以制定针对具体情况的公共政策框架战略和； 2) UH3 实施阶段，将使用 Proctor 的实施成果框架在一项针对 500 名患有不受控制的黑人患者的 20 项初级保健实践的阶梯式楔形集群随机对照试验中进行评估 HTN，PF 策略对 PACE 临床和成本效益的影响。我们还将审查采用情况和实施保真度作为潜在机制可以解释 PF 对血压控制的影响。基本的结果是从基线到 18 个月的血压控制。次要结果是 PACE 的成本效益。这研究结果将提供一个实用且可持续的系统，利用现有的临床和社区资源来建设初级保健实践的能力，以管理少数民族人口的高血压控制。