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

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Article number60
JournalImplementation Science
Volume8
Issue number1
DOIs
StatePublished - Jun 4 2013

Fingerprint

Quality Improvement
Blood Pressure
Hypertension
Primary Health Care
Pragmatic Clinical Trials
Patient Care Management
Guidelines
Cultural Competency
Education
Baltimore
Patient Care
Delivery of Health Care
Research

Keywords

  • Community-based participatory research
  • Health disparities
  • Hypertension
  • Organizational culture
  • Pragmatic trial
  • Quality improvement
  • Study design

ASJC Scopus subject areas

  • Health Policy
  • Medicine(all)
  • Public Health, Environmental and Occupational Health
  • Health Informatics

Cite this

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title = "A multi-level system quality improvement intervention to reduce racial disparities in hypertension care and control: Study protocol",
abstract = "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.",
keywords = "Community-based participatory research, Health disparities, Hypertension, Organizational culture, Pragmatic trial, Quality improvement, Study design",
author = "Cooper, {Lisa A} and Marsteller, {Jill A} and Noronha, {Gary J.} and Flynn, {Sarah J.} and Carson, {Kathryn Anne} and Boonyasai, {Romsai Tony} and Anderson, {Cheryl A.} and Hanan Aboumatar and Debra Roter and Dietz, {Katherine B.} and Miller, {Edgar R} and Prokopowicz, {Gregory P} and Arlene Dalcin and Charleston, {Jeanne B} and Michelle Simmons and Huizinga, {Mary Margaret}",
year = "2013",
month = "6",
day = "4",
doi = "10.1186/1748-5908-8-60",
language = "English (US)",
volume = "8",
journal = "Implementation Science",
issn = "1748-5908",
publisher = "BioMed Central",
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TY - JOUR

T1 - A multi-level system quality improvement intervention to reduce racial disparities in hypertension care and control

T2 - Study protocol

AU - Cooper, Lisa A

AU - Marsteller, Jill A

AU - Noronha, Gary J.

AU - Flynn, Sarah J.

AU - Carson, Kathryn Anne

AU - Boonyasai, Romsai Tony

AU - Anderson, Cheryl A.

AU - Aboumatar, Hanan

AU - Roter, Debra

AU - Dietz, Katherine B.

AU - Miller, Edgar R

AU - Prokopowicz, Gregory P

AU - Dalcin, Arlene

AU - Charleston, Jeanne B

AU - Simmons, Michelle

AU - Huizinga, Mary Margaret

PY - 2013/6/4

Y1 - 2013/6/4

N2 - 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.

AB - 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.

KW - Community-based participatory research

KW - Health disparities

KW - Hypertension

KW - Organizational culture

KW - Pragmatic trial

KW - Quality improvement

KW - Study design

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