Disparities in hypertension control, a major determinant of cardiovascular disease, are driven by a confluence of barriers that operate at patient, provider, healthcare institution, and community levels. Developing multilevel interventions that overcome these barriers can take years, high levels of funding, and infrastructure. Healthcare institutions that serve disparity populations may lack these resources and be unable to rigorously develop and evaluate such complex interventions. The question, then, is how to best adapt evidence-based interventions for hypertension control so institutions can implement and sustain them? Dr. John W. Jackson is an Assistant Professor in the Department of Epidemiology at the Johns Hopkins Bloomberg School of Public Health. Dr. Jackson seeks a K01 Mentored Career Development Award to gain the skills, experience, and preliminary data needed for an independent, methods-focused research program in translational health disparities research. Through the training and research experience outlined in this award, Dr. Jackson will integrate his background in causal inference with methods and theories that capture the ecological complexity of healthcare systems and patient care. The career development plan includes training in (a) systems science (b) implementation science (c) social ecological theory, and (d) cardiovascular disease epidemiology through mentorship, coursework, and participation in working groups, professional development programs, and scientific meetings. Using this training, Dr. Jackson will build microsimulation models that address three critical phases of translational health disparities research.
Aim 1 empirically identifies patient-level factors that a multilevel intervention must address to reduce disparities in a target institution.
Aim 2 empirically identifies the active components of a multilevel intervention that must be translated to the target institution.
Aim 3 estimates the effect of a multilevel intervention in the target institution, after accounting for differences in patient composition and organizational structure.
The Aims will use detailed data from the RICH LIFE Project, a cluster randomized trial of collaborative, stepped care to reduce disparities in hypertension control (the multilevel intervention), along with a retrospective cohort of patients from the Johns Hopkins Community Physicians primary care network (the target institution). This study will lay the groundwork for a theory-informed research program that blends causal inference and systems science methods to guide the translation of disparities-focused interventions to new settings.
Hypertension is a major contributor to the excess cardiovascular morbidity and mortality among racial/ethnic minorities and other socially disadvantaged groups. Multicomponent interventions are being developed to address the multiple pathways that lead to disparities in hypertension control. This project will lay the groundwork for analytic strategies that can accelerate the movement of rigorously evaluated interventions addressing disparities into regular practice and hasten the achievement of equity in cardiovascular health in a racially and socioeconomically diverse population.