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。

• 批准号: 10254412
• 负责人: ARLEEN F. BROWN
• 金额: $ 94.68万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 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/10254412
• 关键词: Address; Adoption; Adult; African American; Antihypertensive Agents; Asian Americans; Asians; 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 regulation; cardiovascular health; community engagement; community organizations; 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; Address; Adoption; Adult; African American; Antihypertensive Agents; Asian Americans; Asians; 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 regulation; cardiovascular health; community engagement; community organizations; 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

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.

项目摘要/摘要 消除美国的种族/族裔心血管健康差异，而不必解决 基于证据的高血压治疗中的差异。在洛杉矶县（LAC），有 大约有801,000拉丁裔，266,000个亚洲人和244,000名患有高血压的非裔美国人 这些人中有一半以上的家庭收入低于联邦贫困水平的200％。在紫胶中 卫生服务部（DHS），美国第二大市政卫生系统，患者，临床医生， 健康的系统和社区因素导致高血压患病率，控制， 以及种族/种族的成果。种族/族裔差距导致LAC DHS的高血压差异 与健康饮食，体育锻炼，肥胖，降压药物治疗的使用有关 药物依从性，社区对高血压的认识以及社区水平的身体和社会 资源。这些差距在LAC DHS中被广泛认可为解决高血压有关的障碍 种族/民族健康差异，但健康的生活方式实践和治疗方面的差异持续存在。我们建议 通过利用我们团队在多种族，多层次的专业知识来大大减少LAC DHS的差异 循证策略，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。我们的建议对Lac DHS提供高质量的使命很敏感 具有成本效益的护理，我们以辅助的重点来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，维持框架（EPIS）框架， 我们提出了一项多层干预措施，以完成高血压控制，该干预将完成EPIS探索/准备 UG3阶段的阶段以及UG4阶段的实施/维持阶段。与所有人合作 51个LAC DHS的成人初级保健诊所，我们的目标是：AIM 1（UG3）：评估多层次（患者，临床医生， 卫生系统的领导和社区）障碍，促进者的障碍，以及在文化上的偏好 - 量身定制的循证实践（EBP）和实施策略具有既定功效 高血压控制。 AIM 2（UG3）：选择并系统地将行为经济学应用于我们的设计 患者，临床医生和社区指导的实施策略，以最大化可接受性，吸收和 效力。 AIM 3（UG4）：在阶梯之间测试我们实施策略的有效性 使用RE-AIM进行聚类随机试验设计，以指导不受控制的高血压评估， 与非少数lac种群和循证实践进行比较。