Lopez Priscilla M, Zanowiak Jennifer, Goldfeld Keith, Wyka Katarzyna, Masoud Ahmad, Beane Susan, Kumar Rashi, Laughlin Phoebe, Trinh-Shevrin Chau, Thorpe Lorna, Islam Nadia
Department of Population Health, NYU School of Medicine, New York, USA.
NYU-CUNY Prevention Research Center, New York, USA.
BMC Health Serv Res. 2017 Dec 6;17(1):810. doi: 10.1186/s12913-017-2767-1.
The Million Hearts® initiative aims to prevent heart disease and stroke in the United States by mobilizing public and private sectors around a core set of objectives, with particular attention on improving blood pressure control. South Asians in particular have disproportionately high rates of hypertension and face numerous cultural, linguistic, and social barriers to accessing healthcare. Interventions utilizing Health information technology (HIT) and community health worker (CHW)-led patient coaching have each been demonstrated to be effective at advancing Million Hearts® goals, yet few studies have investigated the potential impact of integrating these strategies into a clinical-community linkage initiative. Building upon this initiative, we present the protocol and preliminary results of a research study, Project IMPACT, designed to fill this gap in knowledge.
Project IMPACT is a stepped wedge quasi-experimental study designed to test the feasibility, adoption, and impact of integrating CHW-led health coaching with electronic health record (EHR)-based interventions to improve hypertension control among South Asian patients in New York City primary care practices. EHR intervention components include the training and implementation of hypertension-specific registry reports, alerts, and order sets. Fidelity to the EHR intervention is assessed by collecting the type, frequency, and utilization of intervention components for each practice. CHW intervention components consist of health coaching sessions on hypertension and related risk factors for uncontrolled hypertensive patients. The outcome, hypertension control (<140 mmHg systolic blood pressure (BP) and <90 mmHg diastolic BP), is collected at the aggregate- and individual-level for all 16 clinical practices enrolled.
Project IMPACT builds upon the evidence base of the effectiveness of CHW and Million Hearts® initiatives and proposes a unique integration of provider-based EHR and community-based CHW interventions. The project informs the effectiveness of these interventions in team-based care approaches, thereby, helping to develop relevant sustainability strategies for improving hypertension control among targeted racial/ethnic minority populations at small primary care practices.
This study protocol has been approved and is made available on Clinicaltrials.gov by NCT03159533 as of May 17, 2017.
“百万心脏”倡议旨在通过围绕一系列核心目标动员公共和私营部门，来预防美国的心脏病和中风，尤其关注改善血压控制。南亚裔人群的高血压患病率极高，且在获得医疗保健方面面临诸多文化、语言和社会障碍。利用健康信息技术（HIT）和由社区卫生工作者（CHW）主导的患者辅导的干预措施，均已被证明在推进“百万心脏”目标方面是有效的，但很少有研究调查将这些策略整合到临床 - 社区联系倡议中的潜在影响。基于这一倡议，我们展示了一项研究项目“影响项目”（Project IMPACT）的方案和初步结果，该项目旨在填补这一知识空白。
“影响项目”是一项阶梯式楔形准实验研究，旨在测试将由CHW主导的健康辅导与基于电子健康记录（EHR）的干预措施相结合，以改善纽约市初级保健机构中南亚裔患者高血压控制情况的可行性、采用情况和影响。EHR干预组件包括针对高血压的登记报告、警报和医嘱集的培训与实施。通过收集每个机构干预组件的类型、频率和使用情况来评估对EHR干预的依从性。CHW干预组件包括为血压未得到控制的高血压患者提供关于高血压及相关危险因素的健康辅导课程。对于所有纳入研究的16个临床机构，在总体和个体层面收集结果指标，即高血压控制情况（收缩压<140 mmHg和舒张压<90 mmHg）。
“影响项目”建立在CHW和“百万心脏”倡议有效性的证据基础之上，并提出了基于提供者的EHR和基于社区的CHW干预措施的独特整合方式。该项目为这些干预措施在团队式护理方法中的有效性提供了信息，从而有助于制定相关的可持续性策略，以改善小型初级保健机构中目标种族/族裔少数群体的高血压控制情况。
本研究方案已于2017年5月17日获得批准，并在Clinicaltrials.gov上以NCT03159533的编号发布。
