A community‐wide quality improvement initiative to improve hypertension control and reduce disparities

Fortuna, Robert J.; Rocco, Thomas P.; Freeman, Jeffrey S.; Devine, Matthew; Bisognano, John D.; Williams, Geoffrey; Nagel, Angela; Beckman, Howard

doi:10.1111/jch.13469

Cited by 11 publications

(5 citation statements)

References 20 publications

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“…A growing literature supports the effectiveness of some EBIs for reducing inequities in healthcare delivery [47][48][49][50]. Unfortunately, the state of health inequities research is to continue testing the effectiveness of EBIs for different populations and contexts; getting stuck in a loop between efficacy and effectiveness trials [10].…”

Section: Implement What Work and Develop Implementation Strategies Tmentioning

confidence: 99%

Reframing implementation science to address inequities in healthcare delivery

Baumann

Cabassa

2020

BMC Health Serv Res

282

273

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Background: Research has generated valuable knowledge in identifying, understanding, and intervening to address inequities in the delivery of healthcare, yet these inequities persist. The best available interventions, programs and policies designed to address inequities in healthcare are not being adopted in routine practice settings. Implementation science can help address this gap by studying the factors, processes, and strategies at multiple levels of a system of care that influence the uptake, use, and the sustainability of these programs for vulnerable populations. We propose that an equity lens can help integrate the fields of implementation science and research that focuses on inequities in healthcare delivery. Main text: Using Proctor et al.' (12) framework as a case study, we reframed five elements of implementation science to study inequities in healthcare. These elements include: 1) focus on reach from the very beginning; 2) design and select interventions for vulnerable populations and low-resource communities with implementation in mind; 3) implement what works and develop implementation strategies that can help reduce inequities in care; 4) develop the science of adaptations; and 5) use an equity lens for implementation outcomes. Conclusions: The goal of this paper is to continue the dialogue on how to critically infuse an equity approach in implementation studies to proactively address healthcare inequities in historically underserved populations. Our examples provide ways to operationalize how we can blend implementation science and healthcare inequities research.

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Section: Implement What Work and Develop Implementation Strategies Tmentioning

confidence: 99%

Reframing implementation science to address inequities in healthcare delivery

Baumann

Cabassa

2020

BMC Health Serv Res

282

273

View full text Add to dashboard Cite

show abstract

“…Other limitations in this quality improvement study included non-working phone numbers, changes in addresses, transportation barriers, and patient-expressed funding limitations. All these barriers to access are common in low-resource, transient patient populations often served by urban FQHCs (Fortuna et al, 2019).…”

Section: Discussionmentioning

confidence: 99%

Evaluating the efficacy of telephone‐based outreach in addressing hypertension control among black men with severe hypertension: An observational study

Raman

Biola

Bakovic

et al. 2022

Worldviews Ev Based Nurs

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Background:The high prevalence of uncontrolled hypertension (systolic blood pressure [SBP] ≥140 mmHg or diastolic blood pressure [DBP] ≥90 mmHg) in Black patients represents a significant racial health disparity in the United States.Aims: This study evaluated the efficacy of a telephone-based strategy for inviting highrisk patients with severe hypertension to weekly self-management education classes.Further, the study assessed how the outreach intervention correlated with relevant quality improvement outcomes, including improved blood pressure and primary care follow-up among our clinic population of Black men with severe hypertension. Methods: A cohort of 265 Black men aged ≥18 years with SBP ≥160 mmHg or DBP ≥100 mmHg at the most recent clinic visit were identified using Epic reports formatted for Federal Uniformed Data Set annual reporting. Telephone outreach was used to invite the cohort to attend weekly in-person classes facilitated by various healthcare professionals. Logistic regression was performed to determine the associations between being reached by phone with (1) class attendance and (2) follow-up appointment attendance. Results: Most of the Black men were single (57.4%, n = 152), 49.1% had history of alcohol or substance use (n = 130), and 35.8% (n = 95) was uninsured. The average age was 55.6 years (SD = 11.6). After controlling for sociodemographic factors, being reached by phone was significantly associated with an increased likelihood of patient attendance at follow-up appointments (OR = 1.91, p = .038) but not with class attendance (OR = 2.45, p = .155). Patients who attended a follow-up appointment experienced significant reductions in both SBP and DBP at 9 months. Linking evidence to action: Telephone outreach was labor-intensive but effective in keeping under-resourced patient populations engaged in primary care. Future work should aim to develop more efficient strategies for engaging high-risk patients in selfmonitoring education to manage hypertension.

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“…Contemporary approaches to hypertension management are mainly population rather than individual oriented [17][18][19]. Population level initiatives are highly feasible since they use only a single protocol for all individuals but suffer from inherent inability in tailoring interventions to the heterogeneous and changing conditions and contexts of individual residents [20]. Both antihypertension treatment and behavior modi cations belong to life-time endeavor needing continued persistence under complex and dynamically contexts.…”

Section: Introductionmentioning

confidence: 99%

Personalized Hypertension Management Based on Serial Assessment and Telemedicine: a Cluster Randomize Controlled Trial Protocol in Anhui, China

Xiao

Shen

Liu

et al. 2020

Preprint

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Background: Despite tremendous investment worldwide, hypertension treatment and control rates remain low, suggesting that contemporary population-based hypertension management may have reached its efficacy ceiling. The complexity and long-term dynamics of influencing factors make personalized management inevitable and challenging. This protocol describes Personalized Hypertension Management in Anhui, China (PHMA), a project that uses a package of innovative approaches in tailoring interventions to individual patient’s dynamic complications and contexts.Methods/design: PHMA strives to reduce hypertension harms by eight proven “objective behaviors” (e.g., self-monitoring and reporting, healthy diet, physical exercise/activities). These objective behaviors are promoted through five intervention measures: support for self- monitoring, supervised machine communications, daily education or reminder messages, weekly blood pressure notification, and quarterly signed feedback. PHMA uses ten categories and over 300 variables in selecting and refining intervention procedures and content for individual patients. Efficacy of the intervention package is evaluated using a cluster randomized controlled trial design involving a total of 60 site communities and 3352 hypertension patients. Primary measure for the evaluation is systolic and diastolic blood pressure; while secondary evaluation measures include quality of life (EQ5D-5L), occurrence of hypertension-related complications (such as cerebral hemorrhage, coronary heart disease, myocardial or cerebral infarction), healthcare utilization and scores of objective behaviors.Discussion: PHMA uses novel, low cost and sustainable approaches to tailor interventions to the dynamic conditions and contexts of individual patients. Unlike contemporary approaches to hypertension management which are mainly population based, each participant patient in PHMA applies a unique intervention package and all messages, feedbacks and other materials sent out to individual patients are different from each other. PHMA is the first project that adopts so comprehensive tailoring and if proved effective, it should have important implications for future research, practice and policy-making.Trial registration: Registered July 17, 2020. ISRCTN10999269.

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A community‐wide quality improvement initiative to improve hypertension control and reduce disparities

Abstract: Funding informationThe High Blood Pressure Collaborative is funded through an innovative inpatient discharge fee at Rochester hospitals. Insurers, payers, and employers voluntarily agreed to this nominal charge to support the ongoing work of the collaborative.

Cited by 11 publications

References 20 publications

Reframing implementation science to address inequities in healthcare delivery

Reframing implementation science to address inequities in healthcare delivery

Evaluating the efficacy of telephone‐based outreach in addressing hypertension control among black men with severe hypertension: An observational study

Personalized Hypertension Management Based on Serial Assessment and Telemedicine: a Cluster Randomize Controlled Trial Protocol in Anhui, China

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