Collaboration to Improve Blood Pressure in the US Black Belt- Addressing the Triple Threat

合作改善美国黑带血压——应对三重威胁

基本信息

批准号：
9019460
负责人：
Andrea L Cherrington
金额：
$ 83.37万
依托单位：
UNIVERSITY OF ALABAMA AT BIRMINGHAM
依托单位国家：
美国
项目类别：
财政年份：
2015
资助国家：
美国
起止时间：
2015-09-28 至 2016-09-16
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9019460
关键词：
Address Adult Affect African American Age Agriculture Alabama Algorithms Behavior Therapy Blood Pressure Cardiovascular Diseases Caring Characteristics Client satisfaction Cluster randomized trial Collaborations Communities Diabetes Mellitus Effectiveness Electronic Health Record Enrollment Ethnic Origin Feedback Focus Groups Future Geographic Locations Goals Group Interviews Health Healthcare Systems Heart Heart Diseases Hypertension Individual Information Systems Intervention Intervention Trial Life Maryland Measures Medication Management Mental Depression Minority North Carolina Outcome Patients Phase Poverty Practice based research Primary Health Care Process Protocols documentation Provider Quality of Care Quality of life Randomized Randomized Controlled Trials Registries Reporting Research Resources Rest Risk Factors Risk Reduction Rural Sex Characteristics Site Speed Staging Stretching Stroke Structure System Testing Texas United States Agency for Healthcare Research and Quality Universities abstracting arm base blood pressure regulation cardiovascular disorder prevention cardiovascular disorder risk computerized data processing design evidence base experience follow-up health care service utilization health disparity health literacy high risk hypertension control implementation trial improved low socioeconomic status mathematical ability mortality peer primary outcome public health relevance residence satisfaction secondary outcome success treatment as usual trial comparing

项目摘要

DESCRIPTION (Provided By Applicant): The central objective of this proposal is to rigorously compare two strategies designed to improve blood pressure (BP) control in primary care practices serving rural Southeastern African Americans with low socioeconomic status living in the "Black Belt". The Black Belt is in the heart of the Stroke Belt, a geographic area long recognized to have the highest cardiovascular disease mortality in the US. We draw on the growing evidence that practice facilitation (PF), a highly customized, staged approach to helping practices to implement process and structural changes, can enhance the quality of care and improve patient and staff satisfaction, but there is less evidence on its ability to improve outcomes such as BP control. An alternate approach to improving CVD risk factors that is more relationship-focused and with growing evidence of effectiveness involves the use of peer coaches. We and others have shown that peer coaches are effective in Black Belt communities, where mistrust of the healthcare system is common. Using well-established community-based partnerships and the RE-AIM implementation framework, our UH2 Specific Aims are: 1. Engage rural primary care practices, hypertension (HTN) patients, peer coaches, and Community Advisory Boards in AL and NC to collaboratively finalize a PF intervention and a peer coaching intervention, both designed to improve BP in African Americans. 2. Create the data systems for the trial. Our UH3 Specific Aims are: 3. Enroll 80 practices and 25 African American patients with uncontrolled HTN at each practice (total n=2000) in a cluster-randomized, controlled pragmatic implementation trial to compare the two multi- component, multi-level interventions finalized in the UH2 phase with enhanced usual care using a 2 x 2 factorial design. We hypothesize that both interventions will improve BP more than enhanced usual care, and that both interventions delivered together will result in greater improvements in BP than either intervention alone. While we aim to control BP in 75% of participating intervention patients overall, the trial is designed to detect >15% difference in BP control (primary outcome) between the combined intervention and the enhanced usual care arms. Secondary outcomes will include group mean BP differences between baseline and follow- up; quality of life; patient satisfaction; healthcare utilization; and provider and staff satisfaction. The study is designed to examine differences by sex, age, depression, and health literacy/numeracy. Aim 4. Establish scalability of the intervention throughout the entire Black Belt region using extensive process data intended to facilitate future implementation, including practice characteristics, patient characteristics, intervention implementation variables and fidelity measures, as well as focus groups and interviews with patients, peer coaches, facilitators, practice staff, and clinicians. We have extensive experience with community-based peer coaching interventions; PF interventions; health disparities research in CVD; and large multi-site randomized controlled trials engaging real-world practices, assuring the success of the project.

描述（由申请人提供）：该提案的核心目的是严格比较旨在改善血压（BP）控制的策略，以服务于居住在“黑带”中的社会经济地位低下的非洲南非美国人。黑带位于中风带的核心，这是一个长期以来，在美国的心血管疾病死亡率最高的地理区域。我们借鉴了越来越多的证据，即实践设施（PF）是一种高度定制的，分阶段的方法来帮助实施过程和结构变化的实践，可以提高护理质量，并提高患者和员工的满意度，但是关于其改善BP Control等结果的能力的证据较少。改善更多针对关系和越来越多的有效性证据的CVD风险因素的另一种方法是使用同伴教练。我们和其他人表明，同伴教练在黑带社区中有效，在黑带社区中，医疗保健系统的错误很常见。使用良好的社区合作伙伴关系和Re-AIM实施框架，我们的UH2具体目标是：1。参与农村初级保健实践，高血压（HTN）患者，同伴教练和NC和NC的社区咨询委员会，以合作最终确定PF干预和同伴教练干预措施，以提高BP Inforian BP Inforian BP Intry BP。 2。为试验创建数据系统。我们的UH3具体目的是：3。在每种实践（总n = 2000）中，招募80种实践和25名非裔美国人患者在群集随机的，受控的实用实施试验中，以比较两种多组分，多级别的多层干预措施在UH2阶段中最终使用增强的使用2 x 2 x 2 x 2 x 2 x 2 x 2 x 2 x 2 x 2 x 2 x 2 x 2 x 2阶段进行比较。我们假设这两种干预措施都比增强的平常护理可以改善BP，并且两种干预措施共同提供的双方干预措施将使BP的改善更大。虽然我们的目标是控制75％的参与干预患者的BP，但该试验旨在检测合并干预和增强的常规护理臂之间的BP对照（主要结果）差异> 15％。次要结果将包括基线和随访之间的组平均BP差异；生活质量；患者满意度；医疗保健利用；提供者和员工满意度。该研究旨在检查性别，年龄，抑郁和健康素养/算术的差异。 AIM 4。使用旨在促进未来实施的广泛过程数据，在整个黑带地区建立干预措施，包括实践特征，患者特征，干预实施变量和忠诚度措施，以及焦点小组以及对患者，同伴教练，促进者，协助者，实践员工和临床医生的访谈。我们在基于社区的同伴教练干预措施方面拥有丰富的经验； PF干预措施； CVD的健康差异研究；以及大型的多站点随机对照试验参与现实世界实践，确保项目的成功。