Hypertension (HTN) is the number one cause of death for Blacks in the United States and drives the racial disparity in cardiovascular (CV) morbidity and mortality. A major reason for the disproportionate CV morbidity and mortality is poor blood pressure (BP) control. Improving BP control through both primary and secondary prevention efforts leads to significant CV risk reduction in Blacks and can be achieved through evidence-based interventions targeting self-management behaviors. Yet, despite the proven efficacy of these interventions, there is little evidence of their dissemination to community-based settings. The challenge for local health departments is to redesign these evidence-based approaches to function sustainably at the level of resources and skills available in typical community-based organizations. In NYC, the Department of Health and Mental Hygiene (DOHMH) has developed Keep on Track (KOT), a volunteer-run, community program that aims to lower BP of older adults through BP monitoring sessions, brief counseling and health education. With technical and material support from DOHMH, lay health workers (LHW) at faith- based organizations and senior centers take BP readings for community members, record their readings on index cards and provide counseling to support lifestyle change and health care access. An evaluation of KOT has demonstrated promising BP reductions among members who were not lost to follow-up. However, LHWs administrating the program report difficulties managing the volume of tracking cards, and express interest in more effective tools for information management. To address this limitation, the primary aim of this application is to assess the feasibility of implementing a Personal Health Record (PHR) system customized to enable LHWs in two predominately Black churches in NYC to track individual and aggregate changes in BP and health behaviors using a Congregational Dashboard. The secondary aims are to evaluate the effect of the PHR system on changes in BP, physical activity, weight loss, fruit and vegetable intake, and number of visits to a primary care physician from baseline to 9 months. Outcomes for the primary and secondary aims will be assessed at the individual and church-level. A formative evaluation will be conducted throughout the project period, highlighting necessary system modifications and programmatic refinements. A process evaluation will be conducted with a modified version of the mixed-methods RE-AIM framework. BP will be assessed with a validated automated BP monitor. Health behaviors will be assessed with validated self-report measures;weight loss will be estimated as the difference in weight between baseline and 9 months. The long-term goal is to create health IT systems that could build the capacity of community-based organizations to implement evidence-based models of disease prevention and health promotion that are sustainable and generalizable, allowing for broader translation of life-saving interventions across the nation, and laying a foundation for coordination of care from the clinic to the community setting.
This project will lay the foundation for an evidence base for specific PHR functionalities and concurrent workflows for community-based blood pressure monitoring programs, empowered through consumer health IT, to implement core elements of the Chronic Care Model. Developing the feasibility and preliminary accounts of the effectiveness of this use case is an important step towards realizing the potential of consumer health IT to improve the effectiveness of health care for chronic disease and population health outcomes.
