Abstract
BackgroundRacial disparities in blood pressure control have been well documented in the United States. Research suggests that many factors contribute to this disparity, including barriers to care at patient, clinician, healthcare system, and community levels. To date, few interventions aimed at reducing hypertension disparities have addressed factors at all of these levels. This paper describes the design of Project ReD CHiP (Reducing Disparities and Controlling Hypertension in Primary Care), a multi-level system quality improvement project. By intervening on multiple levels, this project aims to reduce disparities in blood pressure control and improve guideline concordant hypertension care.MethodsUsing a pragmatic trial design, we are implementing three complementary multi-level interventions designed to improve blood pressure measurement, provide patient care management services and offer expanded provider education resources in six primary care clinics in Baltimore, Maryland. We are staggering the introduction of the interventions and will use Statistical Process Control (SPC) charting to determine if there are changes in outcomes at each clinic after implementation of each intervention. The main hypothesis is that each intervention will have an additive effect on improvements in guideline concordant care and reductions in hypertension disparities, but the combination of all three interventions will result in the greatest impact, followed by blood pressure measurement with care management support, blood pressure measurement with provider education, and blood pressure measurement only. This study also examines how organizational functioning and cultural competence affect the success of the interventions.DiscussionAs a quality improvement project, Project ReD CHiP employs a novel study design that specifically targets multi-level factors known to contribute to hypertension disparities. To facilitate its implementation and improve its sustainability, we have incorporated stakeholder input and tailored components of the interventions to meet the specific needs of the involved clinics and communities. Results from this study will provide knowledge about how integrated multi-level interventions can improve hypertension care and reduce disparities.Trial RegistrationClinicalTrials.gov NCT01566864
Highlights
Critical health disparities exist between African Americans and their white counterparts in the United States
We worked collaboratively with each clinic site as well as with leaders from the Johns Hopkins Community Physician (JHCP) organization to improve the design of the interventions
Through focus groups and directed interviews, we learned about their concerns regarding certain components of the proposed interventions and we made changes to the intervention design prior to implementation based on their feedback
Summary
Critical health disparities exist between African Americans and their white counterparts in the United States. Cardiovascular disease accounts for more than one-third of the differences in life expectancy between African Americans and whites [1] This disparity is largely attributed to hypertension and poor blood pressure control [1,2]. Interventions to date may address one or another source of disparities [5,6,7], few if any have intervened on multiple actors in the system: patients, clinicians, healthcare organizations and communities. Research suggests that many factors contribute to this disparity, including barriers to care at patient, clinician, healthcare system, and community levels. By intervening on multiple levels, this project aims to reduce disparities in blood pressure control and improve guideline concordant hypertension care
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
