Population Care Management and Team-Based Approach to Reduce Racial Disparities among African Americans/Blacks with Hypertension

Bartolome, Rowena E; Chen, Agnes; Handler, Joel; Platt, Sharon T.; Gould, Bernice

doi:10.7812/tpp/15-052

Cited by 41 publications

(33 citation statements)

References 27 publications

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“…An extensive literature exists on race and hypertension, particularly as it pertains to black patients . Racial disparities in diagnosis, prevalence, treatment, and outcomes, attest to the complex interplay of biologic and environmental factors.…”

Section: Introductionmentioning

confidence: 99%

Clinical presentation and surgical outcomes in primary aldosteronism differ by race

Gershuni

Ermer

Kelz

et al. 2019

Journal of Surgical Oncology

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Background: Primary aldosteronism (PA) is the most common cause of secondary hypertension; early diagnosis and intervention correlate with outcomes. We hypothesized that race may influence clinical presentation and outcomes.Methods: We conducted a retrospective analysis of patients with PA (1997PA ( -2017 who underwent adrenal vein sampling (AVS). Patients were classified by self-reported race as black or non-black. Improvement was defined as postoperative decrease in mean arterial pressure (MAP), antihypertensive medications (AHM), or both.Results: Among patients undergoing AVS (n = 443), 287 underwent adrenalectomy. Black patients (28.2%) had higher body mass index (33.9 vs 31.8 kg/m 2 ; P = .01), longer median duration of hypertension (12 vs 10 years; P = .003), higher modified Elixhauser comorbidity index (2 vs 1; P = .004), and lower median income ($47 134 vs $78 280; P < .001). Black patients had similar aldosterone:renin ratios (150 vs 135.6 [ng/dL]/[ng·mL· −1 hr −1 ]; P = .23) compared to non-blacks. At long-term follow-up, black patients had a similar requirement for AHM (1 vs 0; P = .13) but higher MAP (100.6 vs 95.3 mm Hg; P = .004).Conclusion: Black patients present with longer duration of hypertension and more comorbidities. They are equally likely to lateralize on AVS, suggesting similar disease phenotype. However, black patients demonstrate less improvement with adrenalectomy; this may reflect a delay in diagnosis or concomitant essential hypertension.adrenal, aldosteronoma, disparities, hypertension, primary aldosteronism, race 1 | INTRODUCTION Primary aldosteronism (PA) is the most common etiology of secondary hypertension, affecting 3% to 20% of hypertensive patients 1-4 and 14%to 21% of patients with resistant hypertension. 5 Hyperaldosteronism is associated with end organ dysfunction and cardiovascular morbidity and mortality, independent of level of hypertension. 6-8 As compared to those with essential hypertension, patients with PA have increased risk of myocardial infarction, atrial fibrillation, and stroke, in excess of the projected risk related to degree of hypertension alone. 9 Effective control of blood pressure (BP) and aldosterone level lead to improved cardiovascular outcomes. 10 Therefore, early diagnosis and appropriate treatment of PA is essential to improve cardiovascular outcomes and minimize end organ dysfunction. Subtype differentiation of PA is an essential component of early diagnosis and treatment. Unilateral causes of PA include aldosteroneproducing adenoma and unilateral hyperplasia, which are potentially The authors have no disclosures.surgically curable, while bilateral adrenal hyperplasia (BAH) is managed medically with mineralocorticoid antagonists. 11 Shorter duration of disease has been associated with improved operative outcomes in multiple studies of subjects with unilateral PA. 12,13 An extensive literature exists on race and hypertension, particularly as it pertains to black patients. 14,15 Racial disparities in diagnosis, prevalence, treatment, and outcomes, a...

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Section: Introductionmentioning

confidence: 99%

Clinical presentation and surgical outcomes in primary aldosteronism differ by race

Gershuni

Ermer

Kelz

et al. 2019

Journal of Surgical Oncology

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“…Interestingly, programs designed to address health disparities have been found to be effective in improving blood pressure and lipid control in both racial/ethnic minorities and the overall population. 28,29 We believe that including specific and explicit strategies aimed at narrowing inequality should be a fundamental part of the design of population health programs. These strategies may include the addition of tools to overcome socioeconomic barriers to care, as racial/ethnic minority patients may disproportionately face these barriers, 30 and improve access to care, patient engagement, and patient-provider communication.…”

Section: Discussionmentioning

confidence: 99%

Impact of a Population Health Management Intervention on Disparities in Cardiovascular Disease Control

et al. 2018

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“…In another example, one population care management program for hypertension was able to not only increase rates of blood pressure control for the whole population, but also decrease the gap in blood pressure control between Blacks/African Americans and Whites by strengthening care teams for hypertension and incorporating culturally tailored communication and self-management tools. 35 …”

Section: Key Components Of Diabetes Population Managementmentioning

confidence: 99%

“…Access to information about primary language can help health care systems deliver care in the language most appropriate for each patient. When clinical information systems contain the demographic, socioeconomic, and language information necessary for identifying and targeting potentially vulnerable groups, they can be used by care teams to better tailor care in a way that is both language and culturally appropriate, 3538 leading to improvements in overall quality and a reduction in disparities.…”

Section: Key Components Of Diabetes Population Managementmentioning

confidence: 99%

Population Health Management for Diabetes: Health Care System-Level Approaches for Improving Quality and Addressing Disparities

et al. 2017

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Purpose of review Population care approaches for diabetes have the potential to improve the quality of care and decrease diabetes-related mortality and morbidity. Population care strategies are particularly relevant as Accountable Care Organizations (ACOs), Patient Centered Medical Homes (PCMH), and integrated delivery systems are increasingly focused on managing chronic disease care at the health system level. This review outlines the key elements of population care approaches for diabetes in the current health care environment. Recent findings Population care approaches proactively identify diabetes patients through disease registries and electronic health record data and utilize multi-disciplinary care teams, personalized provider feedback, and decision support tools to target and care for patients at risk for poor outcomes. Existing evidence suggests that these strategies can improve care outcomes and potentially ameliorate existing race/ethnic disparities in health care. However, such strategies may be less effective for patients who are disengaged from the health care system. Summary As population care for diabetes continues to evolve, future initiatives should consider ways to tailor population care to meet individual patient needs, while leveraging improvements in clinical information systems and care integration to optimally manage and prevent diabetes in the future.

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Population Care Management and Team-Based Approach to Reduce Racial Disparities among African Americans/Blacks with Hypertension

Cited by 41 publications

References 27 publications

Clinical presentation and surgical outcomes in primary aldosteronism differ by race

Clinical presentation and surgical outcomes in primary aldosteronism differ by race

Impact of a Population Health Management Intervention on Disparities in Cardiovascular Disease Control

Population Health Management for Diabetes: Health Care System-Level Approaches for Improving Quality and Addressing Disparities

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