Tanvir Hussain1, Whitney Franz2, Emily Brown2, Athena Kan3, Mekam Okoye4, Katherine Dietz5, Kara Taylor2, Kathryn A Carson6, Jennifer Halbert5, Arlene Dalcin5, Cheryl A M Anderson7, Romsai T Boonyasai5, Michael Albert8, Jill A Marsteller9, Lisa A Cooper10. 1. Department of Medicine, University of Nebraska Medical Center; Johns Hopkins Center to Eliminate Cardiovascular Health Disparities. 2. Johns Hopkins Center to Eliminate Cardiovascular Health Disparities; Johns Hopkins Healthcare. 3. Johns Hopkins Center to Eliminate Cardiovascular Health Disparities. 4. Johns Hopkins Center to Eliminate Cardiovascular Health Disparities; Driscoll Children's Hospital, Texas A & M University. 5. Johns Hopkins Center to Eliminate Cardiovascular Health Disparities; Department of Medicine, Johns Hopkins University School of Medicine. 6. Johns Hopkins Center to Eliminate Cardiovascular Health Disparities; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health; Department of Medicine, Johns Hopkins University School of Medicine. 7. Johns Hopkins Center to Eliminate Cardiovascular Health Disparities; Department of Family Medicine and Public Health, University of California San Diego. 8. Johns Hopkins Community Physicians. 9. Johns Hopkins Center to Eliminate Cardiovascular Health Disparities; Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health. 10. Johns Hopkins Center to Eliminate Cardiovascular Health Disparities; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health; Department of Medicine, Johns Hopkins University School of Medicine; Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health.
Abstract
OBJECTIVE: We studied whether care management is a pragmatic solution for improving population blood pressure (BP) control and addressing BP disparities between Blacks and Whites in routine clinical environments. DESIGN: Quasi-experimental, observational study. SETTING AND PARTICIPANTS: 3,964 uncontrolled hypertensive patients receiving primary care within the last year from one of six Baltimore clinics were identified as eligible. INTERVENTION: Three in-person sessions over three months with registered dietitians and pharmacists who addressed medication titration, patient adherence to healthy behaviors and medication, and disparities-related barriers. MAIN MEASURES: We assessed the population impact of care management using the RE-AIM framework. To evaluate effectiveness in improving BP, we used unadjusted, adjusted, and propensity-score matched differences-in-differences models to compare those who completed all sessions with partial completers and non-participants. RESULTS: Of all eligible patients, 5% participated in care management. Of 629 patients who entered care management, 245 (39%) completed all three sessions. Those completing all sessions on average reached BP control (mean BP 137/78) and experienced 9 mm Hg systolic blood pressure (P<.001) and 4 mm Hg DBP (P=.004) greater improvement than non-participants; findings did not vary in adjusted or propensity-score matched models. Disparities in systolic and diastolic BP between Blacks and Whites were not detectable at completion. CONCLUSIONS: It may be possible to achieve BP control among both Black and White patients who participate in a few sessions of care management. However, the very limited reach and patient challenges with program completion should raise significant caution with relying on care management alone to improve population BP control and eliminate related disparities.
OBJECTIVE: We studied whether care management is a pragmatic solution for improving population blood pressure (BP) control and addressing BP disparities between Blacks and Whites in routine clinical environments. DESIGN: Quasi-experimental, observational study. SETTING AND PARTICIPANTS: 3,964 uncontrolled hypertensivepatients receiving primary care within the last year from one of six Baltimore clinics were identified as eligible. INTERVENTION: Three in-person sessions over three months with registered dietitians and pharmacists who addressed medication titration, patient adherence to healthy behaviors and medication, and disparities-related barriers. MAIN MEASURES: We assessed the population impact of care management using the RE-AIM framework. To evaluate effectiveness in improving BP, we used unadjusted, adjusted, and propensity-score matched differences-in-differences models to compare those who completed all sessions with partial completers and non-participants. RESULTS: Of all eligible patients, 5% participated in care management. Of 629 patients who entered care management, 245 (39%) completed all three sessions. Those completing all sessions on average reached BP control (mean BP 137/78) and experienced 9 mm Hg systolic blood pressure (P<.001) and 4 mm Hg DBP (P=.004) greater improvement than non-participants; findings did not vary in adjusted or propensity-score matched models. Disparities in systolic and diastolic BP between Blacks and Whites were not detectable at completion. CONCLUSIONS: It may be possible to achieve BP control among both Black and White patients who participate in a few sessions of care management. However, the very limited reach and patient challenges with program completion should raise significant caution with relying on care management alone to improve population BP control and eliminate related disparities.
Entities:
Keywords:
Care Management; Disparities; Hypertension; Population Health; Primary Care; Quality Improvement
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