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：
10728707
负责人：
NADIA S ISLAM
金额：
$ 134.53万
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 2027-08-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10728707
关键词：
Address Adherence Adoption Behavioral Black Populations Black race Blood Pressure Blood Pressure Monitors Caring Case Manager Clinic Clinical Clinical effectiveness Communication Communities Community Health Aides Consolidated Framework for Implementation Research Counseling Data Decision Making Dissemination and Implementation Effectiveness Evaluation Evidence based intervention Exhibits Goals Guidelines Health Health system Home Home Blood Pressure Monitoring Hypertension Infrastructure Insurance Carriers Intervention Medicaid Methods Minority Groups Modeling Monitor Names New York City Nurses Patients Pharmaceutical Preparations Phase Physicians Primary Care Process Proctor framework Provider Public Health Resources Risk Site Social support System Testing Titrations Training Training Support Transportation Vulnerable Populations Work black patient blood pressure control care coordination community barrier community based participatory research community clinic community engagement cost effectiveness design disparity reduction electronic health record system evidence base experience food insecurity housing instability hypertension control hypertension treatment implementation evaluation implementation fidelity implementation framework implementation outcomes implementation process implementation protocol implementation research implementation strategy implementation/effectiveness improved minority patient mortality disparity patient navigation pilot test primary care practice 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：黑人中的高血压（HTN）控制是由于障碍而在患者，卫生系统，提供者和社区级护理。虽然护士案的功效管理（NCM）和家庭血压监测（HBPM）已妥善处理；这些策略没有解决社区级别的障碍（不稳定的住房，运输）以进行足够的HTN控制，从而限制了它们对黑人的影响。将社区卫生工作者（CHW）整合到初级保健中，以帮助患者导航社区资源对于遇到社区级障碍的患者的HTN控制有效。尽管具有功效，但实施这些多层次循证干预措施（NCM，HBPM和在现实世界的初级保健实践中，将CHW用于常规护理，大多数少数族裔患者接受护理，是次优的。该提议利用练习促进（PF） - 理论上的声音和可持续实施策略，以评估NCM，HBPM和CHW的实施一个集成的社区链接链接模型[实践支持和社区参与（PACE）] 解决患者，医师，卫生系统和社区级别控制黑人的障碍。我们将测试NYU Langone Health中20个主要实践网络的PACE实施纽约市，与既定的社区 - 临床学术咨询委员会和HealthFirst合作（纽约市最大的医疗补助付款人）。实践促进者将协助实践将NCM和HBPM整合到诊所工作流程6个月，此后重新评估患者的BP对照状态；对于那些留下的人不受控制的促进者将协助实践，以开发为护理中加入CHW的流程团队帮助患者导航社区资源并解决社区级别的障碍至最佳HTN 控制。 NCM包括家庭BP远程监控，行为咨询和药物调整/滴定由训练有素的护士。经过培训的CHW与护士合作工作以增强护理协调，并提供健康教练和双向转介在实践和社区资源之间。我们将进行拟议的研究分为两个阶段：1）UG3阶段，该阶段将使用基于社区的参与性的原则研究和实施研究的合并框架，以开发特定于上下文的PF 策略和2）将使用Proctor的实现结果框架的UH3实现阶段评估500例不受控制的黑人患者的20种初级保健实践的跨斜向叶状集群RCT HTN，PF策略对PACE的临床和成本效益的影响。我们还将检查收养实施忠诚度是可能解释PF对BP控制的影响的潜在机制。基本的结果是从基线到18个月的BP控制。次要结果是速度的成本效益。这研究的发现将提供一个实用和可持续的系统，该系统利用现有的临床和社区建立初级保健实践能力来管理少数族裔HTN控制的能力。