Comparative Effectiveness Of Health System Vs. Multi-level Interventions To Reduce Hypertension Disparities

PI: Lisa Cooper, MD, MPH, co-PI Jill Marsteller, PhD, MPP, co-investigators Chidinma Ibe, PhD, Yea-Jen Hsu, PhD, MHA, and Tony Boonyasai, MD, MPH
Funding: Patient-Centered Outcomes Research Institute (PCORI)
Status: Ongoing

Despite the availability of effective therapy, hypertension (HTN) remains a significant contributor to morbidity and mortality in US. Racial and ethnic disparities in HTN prevalence and control persist despite targeted initiatives to reduce disparities. Barriers to reducing disparities in HTN care are complex and include factors related to patients and their families, healthcare providers, practice settings, communities, and policies.

The project will compare the effectiveness of clinic-based standard of care plus audit, feedback, and education (SCP) versus an intervention that uses a collaborative care team, a community health worker, and specialist consultation to deliver contextualized, appropriately stepped care (CC/stepped care) for reducing disparities and improving patient-centered outcomes among patients with HTN, with or without other comorbidities. The research team hypothesizes that CC/stepped care will be more effective than SCP at improving patient blood pressure control and self-management behaviors, and that CC/stepped care will reduce racial/ethnic, socioeconomic, and rural/non-rural disparities to a greater extent than would SCP.

The study uses patient and broad stakeholder engagement and applies principles of community-based participatory research to refine and adapt intervention protocols and materials to the needs of participating organizations, clinic sites, and populations. The stakeholders are included at all phases of the project which also boosts a potential for the project's sustainability and scalability in real-world primary care practices especially among safety-net health centers.

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