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.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Specialized Center (P50)
Project #
Application #
Study Section
Special Emphasis Panel (ZCA1-SRLB-3)
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of North Carolina Chapel Hill
Chapel Hill
United States
Zip Code
Calancie, Larissa; Keyserling, Thomas C; Taillie, Lindsey Smith et al. (2018) TAS2R38 Predisposition to Bitter Taste Associated with Differential Changes in Vegetable Intake in Response to a Community-Based Dietary Intervention. G3 (Bethesda) 8:2107-2119
Wu, Jia-Rong; Cummings, Doyle M; Li, Quefeng et al. (2018) The effect of a practice-based multicomponent intervention that includes health coaching on medication adherence and blood pressure control in rural primary care. J Clin Hypertens (Greenwich) 20:757-764
Jilcott Pitts, Stephanie B; Keyserling, Thomas C; Johnston, Larry F et al. (2017) Examining the Association between Intervention-Related Changes in Diet, Physical Activity, and Weight as Moderated by the Food and Physical Activity Environments among Rural, Southern Adults. J Acad Nutr Diet 117:1618-1627
Thayer, Linden M; Pimentel, Daniela C; Smith, Janice C et al. (2017) Eating Well While Dining Out: Collaborating with Local Restaurants to Promote Heart Healthy Menu Items. Am J Health Educ 48:11-21
Cené, Crystal W; Halladay, Jacqueline R; Gizlice, Ziya et al. (2017) A multicomponent quality improvement intervention to improve blood pressure and reduce racial disparities in rural primary care practices. J Clin Hypertens (Greenwich) 19:351-360
Halladay, Jacqueline R; Donahue, Katrina E; Cené, Crystal W et al. (2017) The association of health literacy and blood pressure reduction in a cohort of patients with hypertension: The heart healthy lenoir trial. Patient Educ Couns 100:542-549
Embree, Genevieve G R; Samuel-Hodge, Carmen D; Johnston, Larry F et al. (2017) Successful long-term weight loss among participants with diabetes receiving an intervention promoting an adapted Mediterranean-style dietary pattern: the Heart Healthy Lenoir Project. BMJ Open Diabetes Res Care 5:e000339
Cené, Crystal W; Halladay, Jacqueline R; Gizlice, Ziya et al. (2016) Associations between subjective social status and physical and mental health functioning among patients with hypertension. J Health Psychol 21:2624-2635
Chatterjee, Avik; Daftary, Genevieve; Gatison, Lenward et al. (2016) Lessons Learned From a Partnership to Evaluate a School Food Program. Prog Community Health Partnersh 10:577-584
Keyserling, Thomas C; Samuel-Hodge, Carmen D; Pitts, Stephanie Jilcott et al. (2016) A community-based lifestyle and weight loss intervention promoting a Mediterranean-style diet pattern evaluated in the stroke belt of North Carolina: the Heart Healthy Lenoir Project. BMC Public Health 16:732

Showing the most recent 10 out of 23 publications