Multi-Method Health System Quality Improvement Intervention to Reduce Hypertension Disparities

NCT01566864 | Completed DMC

• 2 other identifiers: NA_000376225P50HL105187-02
• Study Type: interventional
• Target: 66,570
• Locations: 1 country
• Sites: 1

Brief Summary

The investigators have designed a three-part quality improvement intervention to 1) improve the clinic-based measurement of blood pressure, 2) introduce a care management system to promote self-management behaviors and rapidly titrate medications by algorithms developed in accord with guidelines and 3) introduce an interactive, needs-based, longitudinal-provider education system that promotes patient-centered care and provides practical examples of patient-provider communication strategies. The intervention will occur at six clinics within the metropolitan area of Baltimore, Maryland. The investigators will also describe clinic and health system characteristics and measure their association with implementation (uptake), success (improvements in blood pressure control and reductions in racial disparities), and sustainability of the three-part intervention over 12 -24 months.

Conditions

Hypertension

Keywords

hypertension; disparities; care management; provider education; audit and feedback; Omron; African Americans; organizational change; implementation research

Outcome Measures

Primary Outcomes (1)

• Percent of clinic patients with controlled blood pressure and the racial disparity in controlled BP at each clinic.

  The percent of clinic patients each week with SBP \< 140 and DBP \< 90, or if patient is diabetic or has CKD then SBP \<130 and DBP \< 80. If no BP measure, patient does not meet JNC-7 guidelines. Note: If multiple BP measures are recorded, the lowest will be used. The racial disparity is defined as the percent difference in blood pressure control between white patients and ethnic minority patients (separated into categories of African-American patients and other race patients). These outcomes will be assessed weekly for 24 weeks prior to and after roll out of each of the interventions.

  24 weeks

Secondary Outcomes (5)

• Terminal digit preference

  24 weeks

• Repeat BP measures

  24 weeks

• Patient enrollment in care management

  24 weeks

• Completion of care management program

  24 weeks

• Dashboard review/communication skills training completion

  12 months

Study Arms (3)

Behavioral: Improve clinic based measurement of blood pressur

EXPERIMENTAL

Behavioral: Improve clinic based measurement of blood pressure

Behavioral: Provider education system to promote patient-cent

EXPERIMENTAL

Behavioral: Provider education system to promote patient-centered care

Behavioral: Introduce care management system in clinics

EXPERIMENTAL

Behavioral: Introduce care management system in clinics

Interventions

Improve clinic based measurement of blood pressure BEHAVIORAL

This intervention seeks to improve BP control and reduce disparities through an organizational change and new skills development. To improve the reliability of BP measurement in clinics, new automated BP machines (Omron HEM-907XL) will be provided for each PCP. Medical assistants will be trained and certified in the proper use of the Omron machine by a master trainer. The will be trained to measure the arm circumference, choose the appropriate cuff and place it properly on the arm. They will be recertified yearly. Once activated, the Omron HEM-907XL will lead measurement for 5 minutes then perform a series of 3 BP measurements spaced by 30 seconds and present the man of these 3 measurements. The mean will be record in the electronic medical records.

Behavioral: Improve clinic based measurement of blood pressur

Provider education system to promote patient-centered care BEHAVIORAL

The provider education intervention will address blood pressure control and disparities through audit and feedback. The intervention includes a hypertension dashboard and a linked provider-tailored education intervention. The latter aims to enhance provider communication skills during clinical encounters with hypertension patients, via teaching specific verbal behaviors with practice implications related to elicitation of hypertension treatment and adherence concerns. The dashboard is a web based tool linked to the electronic medical records that imports clinic measurements of BP and offers PCPs a quick assessment of the percentage of those achieving blood pressure control and receiving guideline-concordant care in their panel, clinic, and system overall and by patient race/ethnicity.

Behavioral: Provider education system to promote patient-cent

Introduce care management system in clinics BEHAVIORAL

The care management (CM) intervention will address blood pressure management and disparities through patient education, promotion of self-management, and the introduction of an organizational change through the addition of new team members. The CM team will contact patients with a BP of ≥140/≥90 (≥130/≥80 for patients with diabetes mellitus or chronic kidney disease) as identified through the electronic medical records for enrollment in care management services. Patients with a BP in these ranges will be referred to a CM program that emphasizes four key self-management behaviors: diet, physical activity, medication adherence, and self-monitoring. The self-management promotion program will consist of 3 one-on-one sessions either with a Pharm D. or R.D. over the course of 3 months.

Behavioral: Introduce care management system in clinics

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

Sponsors & Collaborators

• Johns Hopkins University: lead
• Johns Hopkins Community Physicians: collaborator
• National Heart, Lung, and Blood Institute (NHLBI): collaborator

Study Sites (1)

Johns Hopkins Community Physicians

Baltimore, Maryland, 21211, United States

Location

Related Publications (3)

• Block L, Flynn SJ, Cooper LA, Lentz C, Hull T, Dietz KB, Boonyasai RT. Promoting sustainability in quality improvement: an evaluation of a web-based continuing education program in blood pressure measurement. BMC Fam Pract. 2018 Jan 10;19(1):13. doi: 10.1186/s12875-017-0682-5.

  PMID: 29320994 DERIVED

• Boonyasai RT, Carson KA, Marsteller JA, Dietz KB, Noronha GJ, Hsu YJ, Flynn SJ, Charleston JM, Prokopowicz GP, Miller ER 3rd, Cooper LA. A bundled quality improvement program to standardize clinical blood pressure measurement in primary care. J Clin Hypertens (Greenwich). 2018 Feb;20(2):324-333. doi: 10.1111/jch.13166. Epub 2017 Dec 21.

  PMID: 29267994 DERIVED

• Cooper LA, Marsteller JA, Noronha GJ, Flynn SJ, Carson KA, Boonyasai RT, Anderson CA, Aboumatar HJ, Roter DL, Dietz KB, Miller ER 3rd, Prokopowicz GP, Dalcin AT, Charleston JB, Simmons M, Huizinga MM. A multi-level system quality improvement intervention to reduce racial disparities in hypertension care and control: study protocol. Implement Sci. 2013 Jun 4;8:60. doi: 10.1186/1748-5908-8-60.

  PMID: 23734703 DERIVED

Related Links

• Johns Hopkins Center for Health Equity webpage

MeSH Terms

Conditions

Hypertension

Interventions

Ambulatory Care Facilities

Condition Hierarchy (Ancestors)

Vascular Diseases; Cardiovascular Diseases

Intervention Hierarchy (Ancestors)

Health Facilities; Health Care Facilities Workforce and Services

Study Officials

• Lisa A Cooper, MD, MPH

  Johns Hopkins School of Medicine

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: March 22, 2012
• First Posted: March 29, 2012
• Study Start: April 1, 2011
• Primary Completion: April 1, 2015
• Study Completion: April 1, 2015
• Last Updated: January 5, 2018

Record last verified: 2018-01

Data Sharing

• IPD Sharing: Will not share

Locations

US (1)