Reducing Disparities in Hypertension with a Practice-Based Enhanced Care Program Principal Investigator: Darren A. DeWalt, MD, MPH Many racial and ethnic groups and individuals of low socioeconomic status have worse control of hypertension, higher prevalence of cardiovascular disease, and eariier mortality from cardiovascular causes compared to other groups. Potential causes of these disparities have been elucidated, but few studies have investigated interventions specifically designed to narrow the disparity gap and improve outcomes. We will use a community-based participatory research approach to understand the barriers and facilitators faced by both patients and providers and to carefully design and test a practice-based, sustainable, enhanced care intervention for hypertension. The intervention will target medication and lifestyle management at both the patient and practice level, and is designed to narrow disparities in BP control. We will include patients from local primary care practices, including a large community health center and rural practices. The intervention will include an innovative partnership with a nonprofit call center, Connectinc, adding a lifestyle and medication adherence coaching component to their current focus on jobs, employment, and benefits counseling. Although we anticipate improving BP control for everyone, the study focuses on narrowing the racial gap in BP between Whites and African Americans. We will use community-based participatory research approaches to identify the key issues from the patient and practice perspective and invite patients and practices to work with the research team to design the intervention. We will then conduct a cohort study, enrolling 600 participants to determine the effectiveness of the program and its ability to reduce disparities by race and by health literacy status. Lastly, we will rigorously evaluate the costs of implementing and sustaining this practice-based intervention. Assuming it is an effective program, we will begin the process of dissemination using quality improvement strategies as part ofthe North Carolina and national programs for Improving Performance in Practice (IPIP)?a project in 7 states to implement state-based infrastructure facilitating primary care practice-based improvement. Web based training will be made available through the Shared Resource Core internet resource: Center of Excellence for Training and Resource Translation. This study will inform the implementation of evidence-based hypertension quality improvement programs so that sustainable models of care can exist to help reduce health disparities.
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