Background: Hypertension and diabetes represent major risk factors for cardiovascular disease, placing a disproportionate burden on minorities and African Americans. Evidence suggests that interventions that improve control rates would significantly reduce cardiovascular disparities.
Aims : This proposal is based on a collaborative partnership between the Bon Secours Baltimore Health System (BSBHS) and the University of Maryland Baltimore (UMB). The research-specific aims at UMB and BSBHS are complementary and seek to improve provider and patient approaches to treatment of hypertension and diabetes, respectively. UMB also aims to modify physician related barriers to minority enrollment in clinical trials, and BSBHS to improve patient adherence to treatment plans. Through didactic training, UMB aims to build a sustainable research program at BSBHS; through cultural sensitivity training, BSBHS expects to enhance the disparities program at UMB. Methods: The relative impact of physician and/or patient interventions for controlling hypertension and diabetes is assessed. This is a hypothesis-testing, prospective study, with an experimental 2X2 factorial design; it is a four-arm randomized controlled trial. Outcomes include adherence and improved knowledge/awareness of guidelines (of patients and their physicians), as well as patient clinical and quality of life measures. The study is powered for the proportion of patients who get to goal. We target enrollment of 800 patients (each for hypertension and diabetes), to afford 80% (up to 90%) power and allow for 25% attrition. We will use logistic regression for the probability of reaching goal, multiple linear regression for relative changes in mmHg (hypertension) and HbAlc (diabetes), and survival analysis to model time to reach goal. We will also measure improved adherence of diabetes patients as a result of BSBHS actively identifying access barriers; and changes in the willingness of patients to enroll in clinical trials as a result of physician-targeted education. Discussion: We seek to demonstrate a best practice model, based on a collaborative partnership, and build a self-sustained research program at BSBHS and an enhanced cardiovascular disparities program at UMB. Community entities will have full access to resources at both institutions, which in turn will have access to invaluable input and support from community groups. We strongly expect improved outcomes/awareness of cardiovascular health among minority patients serviced by both BSBHS and UMB.
