The overarching goal of this proposal is to develop, adapt, implement, and evaluate hypertension control interventions in safety-net settings caring for race/ethnic minority patients with complex co-morbid conditions including chronic kidney disease (CKD) and diabetes. Dr. Bibbins-Domingo is the joint PI of a U54 collaborative grant that evaluates a clinically-delivered hypertension control intervention consisting of a clinical blood pressure control algorithm, as well as a culturally-tailored dietary intervention aimed at sustained blood pressure control delivered in an integrated health delivery system;these interventions will form the basis for the adapted interventions studied here. The proposal addresses the following aims:
Aim 1. To adapt, implement, and evaluate hypertension interventions developed in the U54 to resource- limited, safety net settings in across California, and Aim 2. To use a new micro-simulation computer model to determine essential elements of effective hypertension interventions and an established population-based computer model (the CVD Policy Model) to project population impact of such interventions on health disparities. This proposal will enhance Dr. Bibbins-Domingo's career goals to pursue didactic and experiential training in implementation science methodologies, to develop multi-disciplinary teams of researchers (including nephrologists, cardiologists, and implementation scientists) capable of developing effective prevention interventions for delivery in resource-limited settings caring for complex patients, and to integrate her prior computer modeling work in the analysis of new clinically-based interventions. She will conduct the work described here through mentored studies involving trainees from a broad set of disciplines. Dr. Bibbins- Domingo is the Director of the UCSF Center for Vulnerable Populations at San Francisco General Hospital and the Director of the Clinical and Translational Sciences Institute K Scholars Program that mentors junior faculty with career development awards. She has a long track record of mentoring trainees and junior faculty, including sub-specialists (i.e. nephrologist, cardiologists, endocrinologists) and several individuals from URM backgrounds. This proposal will develop new science while providing a rich training environment for junior investigators and furthering Dr. Bibbins-Domingo's own career development.

Public Health Relevance

This proposal seeks to develop effective hypertension control interventions in safety-net settings caring for race/ethnic minority patients with complex co-morbid conditions including chronic kidney disease and diabetes, and to use computer simulations to evaluate these interventions for their population impact on disparities. This proposal enhances the career development of the PI, while allowing her to develop a rich training environment for junior investigators from a range of disciplines.

National Institute of Health (NIH)
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Midcareer Investigator Award in Patient-Oriented Research (K24)
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Study Section
Diabetes, Endocrinology and Metabolic Diseases B Subcommittee (DDK)
Program Officer
Rankin, Tracy L
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University of California San Francisco
Internal Medicine/Medicine
Schools of Medicine
San Francisco
United States
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Lyles, Courtney R; Lunn, Mitchell R; Obedin-Maliver, Juno et al. (2018) The new era of precision population health: insights for the All of Us Research Program and beyond. J Transl Med 16:211
GutiƩrrez, Orlando M; Limou, Sophie; Lin, Feng et al. (2018) APOL1 nephropathy risk variants do not associate with subclinical atherosclerosis or left ventricular mass in middle-aged black adults. Kidney Int 93:727-732
Mayeda, Elizabeth Rose; Banack, Hailey R; Bibbins-Domingo, Kirsten et al. (2018) Can Survival Bias Explain the Age Attenuation of Racial Inequalities in Stroke Incidence?: A Simulation Study. Epidemiology 29:525-532
Dehmer, Elizabeth W; Phadnis, Milind A; Gunderson, Erica P et al. (2018) Association Between Gestational Diabetes and Incident Maternal CKD: The Coronary Artery Risk Development in Young Adults (CARDIA) Study. Am J Kidney Dis 71:112-122
Ishida, Julie H; Auer, Reto; Vittinghoff, Eric et al. (2017) Marijuana Use and Estimated Glomerular Filtration Rate in Young Adults. Clin J Am Soc Nephrol 12:1578-1587
Banerjee, Tanushree; Crews, Deidra C; Wesson, Donald E et al. (2017) Food Insecurity, CKD, and Subsequent ESRD in US Adults. Am J Kidney Dis 70:38-47
Fontil, Valy; Bibbins-Domingo, Kirsten; Nguyen, Oanh Kieu et al. (2017) Management of Hypertension in Primary Care Safety-Net Clinics in the United States: A Comparison of Community Health Centers and Private Physicians' Offices. Health Serv Res 52:807-825
Kramer, Holly; Colangelo, Laura; Lewis, Cora E et al. (2017) Cumulative Exposure to Systolic Blood Pressure During Young Adulthood Through Midlife and the Urine Albumin-to-Creatinine Ratio at Midlife. Am J Hypertens 30:502-509
Bansal, Nisha; Lin, Feng; Vittinghoff, Eric et al. (2016) Estimated GFR and Subsequent Higher Left Ventricular Mass in Young and Middle-Aged Adults With Normal Kidney Function: The Coronary Artery Risk Development in Young Adults (CARDIA) Study. Am J Kidney Dis 67:227-34
Peralta, Carmen A; Bibbins-Domingo, Kirsten; Vittinghoff, Eric et al. (2016) APOL1 Genotype and Race Differences in Incident Albuminuria and Renal Function Decline. J Am Soc Nephrol 27:887-93

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