Document text
Principal Investigator: Julie Christine Lauffenburger
Organization: BRIGHAM AND WOMEN'S HOSPITAL
Fiscal Year: 2024
Award: $651,149
Funding agency: National Institute on Minority Health and Health Disparities
ABSTRACT
Hypertension affects one in three US adults, yet only 50% have their blood pressure adequately controlled. Hypertension is twice as prevalent in black adults than non-Hispanic whites; consequently, blacks are 2 to 3 times more likely to die of hypertension-related heart disease than their white counterparts. While many factors may contribute to these disparities, a lack of treatment intensification, the underuse or prescribing of oral antihypertensives, and lower rates of follow-up care are thought to be central.
Health information technology (health IT) solutions, such as decision support in electronic health record (EHR) systems, could help reduce these gaps in care, but few studies have evaluated the use of these strategies in health systems caring for a large population of minority patients. Similarly, while decision support has been widely-used, it has rarely been employed to emphasize racial differences in care, to support treatment recommendations for Black patients, or to help address challenges in access to care that are more common among racial/ethnic minority subgroups. Decision support has generally been used as a single approach and has not been integrated with other health IT strategies like patient portals to improve patient communication. More generally, most tools have also not been designed using principles from the rapidly-emerging field of behavioral science.
To this end, we propose a pragmatic randomized effectiveness-implementation hybrid type 2 trial to test the impact of a multicomponent health IT intervention on racial and ethnic disparities in hypertension control. This trial will be conducted at Advocate Health, the largest integrated delivery network in Illinois, which serves a large patient population throughout the Chicago area and has extensive experience conducting research studies and pragmatic clinical trials with numerous academic partners.
The specific aims of the study are to: (1) design and pilot test health IT tools to address racial/ethnic disparities in hypertension control using a patient advisory board and provider focus groups; (2) conduct a 2-arm pragmatic cluster randomized trial with partial crossover to determine whether health IT tools improve blood pressure control and reduce racial/ethnic disparities; and (3) evaluate the acceptability and adoptability of the health IT interventions by patients, providers, and clinics, including whether the intervention reduces disparities in adoption rates of patient portals.
Using a rigorous randomized design, we have proposed a pragmatic and scalable approach to optimizing health IT tools to address disparities. Our multidisciplinary study team consists of experts in racial/ethnic disparities, hypertension, health IT, patient and provider behavior change, and pragmatic trials. The expected overall impact of this innovative proposal is that it will fundamentally advance how health IT can be optimized to improve health disparities in ways that are scalable and integrated into healthcare systems.
Terms: <2 arm RCT><2 arm randomized control trial><2 arm randomized controlled trial><21+ years old><Active Follow-up><Address><Adopted><Adoption><Adult><Adult Human><Advocate><Affect><Anti-Hypertensive Agents><Anti-Hypertensive Drugs><Anti-Hypertensives><Apoplexy><Area><Assess implementation><BP control><BP management><Behavioral Sciences><Black Populations><Black group><Black individual><Black people><Blacks><Blood Pressure><Brain Vascular Accident><Cardiac Diseases><Cardiac Disorders><Caring><Cerebral Stroke><Cerebrovascular Apoplexy><Cerebrovascular Stroke><Chicago><Clinic><Clinical Trials><Cluster randomization trial><Cluster randomized trial><Communication><Data><Decrease disparity><Decrease health disparities><Disparities><Disparity><Drug Prescribing><Drug Prescriptions><EHR system><Electronic Health Record><Electronics><Ensure><Focus Groups><Grant><Guidelines><Health><Health Care Systems><Health disparity mitigation><Health disparity reduction><Healthcare Systems><Heart Diseases><Hispanic><Home Blood Pressure Monitoring><Hypertension><Hypotensive Agent><Hypotensive Drugs><Illinois><Implementation assessment><Individual><Individuals from minority><Individuals of minority><Intervention><Intervention Strategies><Latino Population><Latino group><Latino individual><Latino people><Latinos><Lower disparity><Lower health disparities><Minority><Minority Groups><Minority People><Minority Population><Minority individual><Mitigate health disparities><Non-Hispanic><Nonhispanic><Not Hispanic or Latino><Oral><Patient Care><Patient Care Delivery><Patients><Physicians><Pragmatic clinical trial><Provider><QOC><Quality of Care><Race><Races><Randomization trial><Randomized><Recommendation><Reduce health disparities><Reporting><Research Resources><Resources><Self Blood Pressure Monitoring><Social Service><Social Work><Specialty><Stroke><Subgroup><Testing><Time><Triage><Vascular Hypertensive Disease><Vascular Hypertensive Disorder><Visit><active followup><adulthood><anti-hypertension><arm><barrier to care><barrier to health care><barrier to healthcare><barrier to treatment><behavior change><blood pressure control><blood pressure management><brain attack><care as usual><care for patients><care of patients><caring for patients><cerebral vascular accident><cerebrovascular accident><clinical decision support><clinical practice><clinician behavior><design><designing><differences due to race><differences in race><differs by race><differs in race><disparities in race><disparity due to race><disparity in ethnic><disparity in health><disparity reduction><effectiveness/implementation hybrid><electronic><electronic device><electronic health care record><electronic health medical record><electronic health plan record><electronic health record system><electronic health registry><electronic medical health record><ethnic based disparity><ethnic disadvantage><ethnic disparity><ethnic inequality><ethnic inequity><ethnic minority><ethnicity disparity><evaluate implementation><evaluation of implementation><experience><follow up><follow-up><followed up><followup><health disparity><health information technology><heart disorder><high blood pressure><hybrid type 2 trial><hybrid type II trial><hyperpiesia><hyperpiesis><hypertension control><hypertension management><hypertensive disease><hypertensive disorder><implementation evaluation><improved><inequality due to race><inequity due to race><innovate><innovation><innovative><insight><intervention arm><interventional strategy><medical specialties><medication prescription><minority patient><mitigate disparity><multi-ethnic><multidisciplinary><multiethnic><obstacle to care><obstacle to healthcare><patient outreach><patient population><patient portal><patient-clinician communication><patient-doctor communication><patient-provider communication><patients from minority><patients of minority><physician behavior><pilot test><pragmatic effectiveness trial><pragmatic trial><prescribed medication><primary outcome><provider behavior><race based differences><race based disparity><race based inequality><race based inequity><race differences><race disparity><race related differences><race related disparity><race related inequality><race related inequity><racial><racial background><racial difference><racial disparity><racial diversity><racial inequality><racial inequity><racial minority><racial origin><racially different><racially diverse><racially unequal><randomisation><randomization><randomized trial><randomly assigned><recruit><reduce disparity><reduction in disparity><research study><routine care><secondary outcome><stroked><strokes><study population><technology intervention><technology-based interventions><technology-enabled interventions><technology-focused interventions><tool><treatment arm><treatment as usual><trial comparing><two arm RCT><two arm randomized control trial><two arm randomized controlled trial><usual care>