REDUCING DISPARITIES IN HYPERTENSION WITH A PRACTICE-BASED ENHANCED CARE PROGRAM

通过基于实践的强化护理计划减少高血压方面的差异

基本信息

批准号：
8377190
负责人：
DARREN A DEWALT
金额：
$ 59.4万
依托单位：
UNIV OF NORTH CAROLINA CHAPEL HILL
依托单位国家：
美国
项目类别：
财政年份：
资助国家：
美国
起止时间：
至
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/8377190
关键词：
Address Adherence African American Blood Pressure Calories Cardiovascular Diseases Cardiovascular system Caring Clinic Cohort Studies Communities Community Health Centers Community Practice Counseling County Diet Educational Intervention Effectiveness of Interventions Employment Enrollment Ethnic group Genes Genetic Determinism Health Healthcare Systems High Prevalence Hypertension Hypotension Individual Internet Intervention Life Style Link Medication Management Modeling North Carolina Occupations Online Systems Outcome Participant Patients Performance Pharmaceutical Preparations Phase Physical activity Primary Health Care Principal Investigator Process Program Effectiveness Provider Race Research Research Infrastructure Research Personnel Resource Sharing Resources Rural Socioeconomic Status Sodium Source System Testing Training Translations Variant Work base blood pressure regulation cardiovascular risk factor care preference cohort community based participatory research cost design environmental change evidence base experience health disparity health literacy hypertension control improved innovation intervention effect lifestyle factors literacy low socioeconomic status medication compliance mortality programs therapy design

项目摘要

Reducing Disparities in Hypertension with a Practice-Based Enhanced Care Program Principal Investigator: Darren A. DeWalt, MD, MPH Many racial and ethnic groups and individuals of low socioeconomic status have worse control of hypertension, higher prevalence of cardiovascular disease, and eariier mortality from cardiovascular causes compared to other groups. Potential causes of these disparities have been elucidated, but few studies have investigated interventions specifically designed to narrow the disparity gap and improve outcomes. We will use a community-based participatory research approach to understand the barriers and facilitators faced by both patients and providers and to carefully design and test a practice-based, sustainable, enhanced care intervention for hypertension. The intervention will target medication and lifestyle management at both the patient and practice level, and is designed to narrow disparities in BP control. We will include patients from local primary care practices, including a large community health center and rural practices. The intervention will include an innovative partnership with a nonprofit call center, Connectinc, adding a lifestyle and medication adherence coaching component to their current focus on jobs, employment, and benefits counseling. Although we anticipate improving BP control for everyone, the study focuses on narrowing the racial gap in BP between Whites and African Americans. We will use community-based participatory research approaches to identify the key issues from the patient and practice perspective and invite patients and practices to work with the research team to design the intervention. We will then conduct a cohort study, enrolling 600 participants to determine the effectiveness of the program and its ability to reduce disparities by race and by health literacy status. Lastly, we will rigorously evaluate the costs of implementing and sustaining this practice-based intervention. Assuming it is an effective program, we will begin the process of dissemination using quality improvement strategies as part ofthe North Carolina and national programs for Improving Performance in Practice (IPIP)¿a project in 7 states to implement state-based infrastructure facilitating primary care practice-based improvement. Web based training will be made available through the Shared Resource Core internet resource: Center of Excellence for Training and Resource Translation. This study will inform the implementation of evidence-based hypertension quality improvement programs so that sustainable models of care can exist to help reduce health disparities.

通过基于实践的增强护理计划来减少高血压的差异首席研究员：Darren A. Dewalt，医学博士，MPH 许多种族和种族以及社会经济地位低的个人对与其他群体相比，高血压，心血管疾病的较高患病率以及心血管原因的早期死亡率。这些差异的潜在原因已经阐明，但是很少有研究研究专门设计的干预措施来缩小差异差距和改善预后。我们将使用基于社区的参与研究方法来了解患者和提供者面临的障碍和促进者，并仔细设计和测试一种基于实践的，可持续的，增强的护理干预措施，以实现高血压。干预措施将针对患者和练习水平的药物和生活方式管理，并旨在缩小BP控制中的分布。我们将包括当地初级保健实践的患者，包括大型社区健康中心和粗暴的习惯。干预措施将包括与非营利性呼叫中心（Connectinc）建立创新的合作伙伴关系，将生活方式和药物依从性教练组成部分添加到他们当前对工作，就业和福利咨询方面的关注。尽管我们预计每个人都会改善BP的控制，但该研究的重点是缩小白人与非裔美国人之间BP的种族差距。我们将使用基于社区的参与研究方法来确定患者的关键问题，并实践观点和邀请患者和实践与研究团队合作以设计干预措施。然后，我们将进行一项队列研究，招募600名参与者，以确定该计划的有效性及其通过种族和健康素养状况降低差异的能力。最后，我们将严格评估实施和维持这种基于实践的干预措施的成本。假设这是一项有效的计划，我们将开始使用质量改进策略作为北卡罗来纳州的一部分和国家改善实践绩效（IPIP）的国家计划的一部分开始传播过程。在7个州的一个项目中，实施了一个基于国家基础的基础设施，以支持基于初级保健实践的改进。基于Web的培训将通过共享资源核心Internet资源提供：培训和资源翻译的卓越中心。这项研究将为实施基于证据的高血压质量改进计划的实施提供信息，以便可以使用可持续的护理模型来帮助减少健康分布。