A multi-level system quality improvement intervention to reduce racial disparities in hypertension care and control: study protocol

Implementation Science

Mary Margaret Huizinga⁴  Michelle Simmons⁸  Jeanne B Charleston⁷  Arlene T Dalcin⁷  Gregory P Prokopowicz⁷  Edgar R Miller⁷  Katherine B Dietz⁷  Debra L Roter⁵  Hanan J Aboumatar⁷  Cheryl A Anderson⁶  Romsai T Boonyasai⁷  Kathryn A Carson³  Sarah J Flynn⁷  Gary J Noronha²  Jill A Marsteller¹  Lisa A Cooper⁷ 

[1] Department of Health Policy and Management

[2] , Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA;Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA;Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA;Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA;Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA;Department of Family and Preventative Medicine, University of California San Diego School of Medicine, La Jolla, California, USA;Department of Medicine, Johns Hopkins University School of Medicine, 2024 East Monument Street, Suite 2-515, Baltimore, Maryland 21287, USA;Community and Provider Advisory Board, Johns Hopkins Center to Eliminate Cardiovascular Health Disparities, Baltimore, Maryland, USA

关键词: Study design;    Community-based participatory research;    Organizational culture;    Pragmatic trial;    Health disparities;    Hypertension;    Quality improvement;   

Others  :  813613
DOI  :  10.1186/1748-5908-8-60

 received in 2013-03-14, accepted in 2013-05-24,  发布年份 2013

【 摘 要 】

Background

Racial 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.

Methods

Using 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.

Discussion

As 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 Registration

ClinicalTrials.gov NCT01566864

【 授权许可】

   
2013 Cooper et al.; licensee BioMed Central Ltd.

【 图 表 】

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