Multi-ethnic Multi-level Strategies and Behavioral Economics to Eliminate Hypertension Disparities in LA County.

消除洛杉矶县高血压差异的多种族多层次策略和行为经济学。

基本信息

批准号：
10477370
负责人：
ARLEEN F. BROWN
金额：
$ 100.82万
依托单位：
UNIVERSITY OF CALIFORNIA LOS ANGELES
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/10477370
关键词：
Address Adoption Adult African American Antihypertensive Agents Asian Asian Americans Awareness Cardiovascular Diseases Caring Cerebrovascular Disorders Chronic Kidney Failure Clinic Clinical Cluster randomized trial Combined Modality Therapy Communities Community Health Aides Congestive Heart Failure County Dose Education Effectiveness Electronic Health Record Ethnic Origin Ethnic group Evidence based practice Evidence based treatment Exploration Preparation Implementation and Sustainment Exposure to Filipino Health Food Health Services Health system Healthy Eating Heart Diseases Heart failure Household Hypertension Income Individual Intervention Kidney Diseases Latino Leadership Level of Evidence Life Expectancy Link Los Angeles Medication Management Mediterranean Diet Methods Mission Modification Municipalities Myocardial Ischemia Obesity Outcome Patients Pharmacists Pharmacotherapy Phase Physical activity Physicians Preparation Prevalence Primary Health Care Process Race Reach Effectiveness Adoption Implementation and Maintenance Resources Schedule Self Perception Services Subgroup System Transportation Visit behavioral economics blood pressure control cardiovascular health community barrier community engagement community organizations community-level factor cost cost effective design disease disparity disparity reduction effectiveness testing ethnic health disparity evidence base federal poverty level health disparity healthy lifestyle hypertension control hypertension treatment implementation outcomes implementation process implementation science implementation strategy improved innovation medication compliance mortality multi-ethnic personal narratives pill population based preference public-private partnership racial and ethnic shared decision making social social norm supported housing sustainability framework trial design uptake

项目摘要

Project Summary/Abstract Eliminating racial/ethnic cardiovascular health disparities in the U.S. cannot be achieved without addressing disparities in evidence-based treatment of hypertension. In Los Angeles County (LAC), there are approximately, 801,000 Latino, 266,000 Asian, and 244,000 African American adults with hypertension, and more than half of these individuals have household income below 200% of the federal poverty level. In the LAC Department of Health Services (DHS), the second largest municipal health system in the US, patient, clinician, healthy system, and community factors contribute to substantial disparities in hypertension prevalence, control, and outcomes by race/ethnicity. Racial/ethnic gaps that contribute to hypertension disparities in LAC DHS relate to differences in healthy eating, physical activity, obesity, antihypertensive pharmacotherapy use, medication adherence, community awareness of hypertension, and community-level physical and social resources. These gaps are widely recognized in LAC DHS as barriers to addressing hypertension-related racial/ethnic health disparities, yet differences in healthy lifestyle practices and treatment persist. We propose to significantly reduce disparities in in LAC DHS by leveraging our team's expertise in multi-ethnic, multi-level evidence-based strategies, community/stakeholder engagement, public-private partnerships, implementation science, and behavioral economics. Our proposal is sensitive to LAC DHS' mission of providing high quality, cost-effective care, which we address with an ancillary focus on reducing the high cost of hypertension-related heart and kidney disease. Using the Exploration, Preparation, Implementation, Sustainment (EPIS) framework, we propose a multi-level intervention for hypertension control that will complete EPIS Exploration/Preparation stages in the UG3 phase and the Implementation/Sustainment stages in the UG4 phase. In partnership with all 51 adult primary care clinics in LAC DHS, our aims are: Aim 1 (UG3): Assess multi-level (patient, clinician, health system leadership, and community) barriers to, facilitators of, and preferences for a menu of culturally- tailored evidence-based practices (EBPs) and implementation strategies with established efficacy for hypertension control. Aim 2 (UG3): Select and systematically apply behavioral economics to the design of our patient-, clinician-, and community-directed implementation strategies to maximize acceptability, uptake, and effectiveness. Aim 3 (UG4): Test the effectiveness of our implementation strategies in a stepped-wedge cluster randomized trial design using RE-AIM to guide assessment of uncontrolled hypertension, disparities in comparison to non-minority LAC populations, and evidence-based practices.

项目概要/摘要如果不解决问题，就无法消除美国的种族/民族心血管健康差异高血压循证治疗的差异。在洛杉矶县 (LAC)，有大约 801,000 名拉丁裔、266,000 名亚裔和 244,000 名非裔美国成年人患有高血压，其中一半以上的家庭收入低于联邦贫困线的 200%。在实控线卫生服务部 (DHS)，美国第二大市政卫生系统，患者、临床医生、健康系统和社区因素导致高血压患病率、控制率、以及按种族/民族划分的结果。导致拉丁美洲和加勒比地区 DHS 高血压差异的种族/民族差距与健康饮食、体力活动、肥胖、抗高血压药物治疗使用的差异有关，药物依从性、社区对高血压的认识以及社区层面的身体和社会资源。拉丁美洲和加勒比地区国土安全部广泛认为这些差距是解决高血压相关问题的障碍种族/民族健康差异，但健康生活方式和治疗方面的差异仍然存在。我们建议利用我们团队在多种族、多层次方面的专业知识，显着减少拉美和加勒比地区国土安全部的差异循证战略、社区/利益相关者参与、公私伙伴关系、实施科学和行为经济学。我们的提案对 LAC DHS 的使命敏感，即提供高质量、具有成本效益的护理，我们重点关注降低高血压相关的高成本心脏和肾脏疾病。使用探索、准备、实施、维持 (EPIS) 框架，我们提出了高血压控制的多层次干预措施，以完成 EPIS 探索/准备 UG3 阶段中的阶段和 UG4 阶段中的实施/维持阶段。与所有人合作 LAC DHS 的 51 家成人初级保健诊所，我们的目标是：目标 1 (UG3)：评估多层次（患者、临床医生、卫生系统领导层和社区）对文化菜单的障碍、促进者和偏好量身定制的循证实践（EBP）和具有既定功效的实施策略高血压控制。目标 2 (UG3)：选择行为经济学并系统地应用到我们的设计中以患者、临床医生和社区为导向的实施策略，以最大限度地提高可接受性、采用率和效力。目标 3 (UG4)：在阶梯楔形中测试我们实施策略的有效性使用 RE-AIM 的整群随机试验设计来指导评估不受控制的高血压、与非少数民族 LAC 人群的比较以及基于证据的实践。