Lisa A Cooper1, Jill A Marsteller2, Kathryn A Carson3, Katherine B Dietz4, Romsai T Boonyasai5, Carmen Alvarez6, Chidinma A Ibe5, Deidra C Crews7, Hsin-Chieh Yeh3, Edgar R Miller3, Cheryl R Dennison-Himmelfarb8, Lisa H Lubomski5, Tanjala S Purnell3, Felicia Hill-Briggs9, Nae-Yuh Wang3. 1. Johns Hopkins University School of Medicine, Baltimore, MD, USA; Johns Hopkins Center for Health Equity, Johns Hopkins University, Baltimore, MD, USA; The Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. Electronic address: lisa.cooper@jhmi.edu. 2. Johns Hopkins University School of Medicine, Baltimore, MD, USA; Johns Hopkins Center for Health Equity, Johns Hopkins University, Baltimore, MD, USA; The Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Johns Hopkins University School of Medicine, Baltimore, MD, USA. 3. Johns Hopkins University School of Medicine, Baltimore, MD, USA; Johns Hopkins Center for Health Equity, Johns Hopkins University, Baltimore, MD, USA; The Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. 4. Johns Hopkins University School of Medicine, Baltimore, MD, USA; Johns Hopkins Center for Health Equity, Johns Hopkins University, Baltimore, MD, USA. 5. Johns Hopkins University School of Medicine, Baltimore, MD, USA; Johns Hopkins Center for Health Equity, Johns Hopkins University, Baltimore, MD, USA; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. 6. Johns Hopkins Center for Health Equity, Johns Hopkins University, Baltimore, MD, USA; John Hopkins University School of Nursing, Baltimore, MD, USA. 7. Johns Hopkins University School of Medicine, Baltimore, MD, USA; Johns Hopkins Center for Health Equity, Johns Hopkins University, Baltimore, MD, USA; The Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. 8. Johns Hopkins University School of Medicine, Baltimore, MD, USA; Johns Hopkins Center for Health Equity, Johns Hopkins University, Baltimore, MD, USA; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; John Hopkins University School of Nursing, Baltimore, MD, USA. 9. Johns Hopkins University School of Medicine, Baltimore, MD, USA; Johns Hopkins Center for Health Equity, Johns Hopkins University, Baltimore, MD, USA; The Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; John Hopkins University School of Nursing, Baltimore, MD, USA.
Abstract
Disparities in the control of hypertension and other cardiovascular disease risk factors are well-documented in the United States, even among patients seen regularly in the healthcare system. Few existing approaches explicitly address disparities in hypertension care and control. This paper describes the RICH LIFE Project (Reducing Inequities in Care of Hypertension: Lifestyle Improvement for Everyone) design. METHODS:RICH LIFE is a two-arm, cluster-randomized trial, comparing the effectiveness of enhanced standard of care, "Standard of Care Plus" (SCP), to a multi-level intervention, "Collaborative Care/Stepped Care" (CC/SC), for improving blood pressure (BP) control and patient activation and reducing disparities in BP control among 1890 adults with uncontrolled hypertension and at least one other cardiovascular disease risk factor treated at 30 primary care practices in Maryland and Pennsylvania. Fifteen practices randomized to the SCP arm receive standardized BP measurement training; race/ethnicity-specific audit and feedback of BP control rates; and quarterly webinars in management practices, quality improvement and disparities reduction. Fifteen practices in the CC/SC arm receive the SCP interventions plus implementation of the collaborative care model with stepped-care components (community health worker referrals and virtual specialist-panel consults). The primary clinical outcome is BP control (<140/90 mm Hg) at 12 months. The primary patient-reported outcome is change from baseline in self-reported patient activation at 12 months. DISCUSSION: This study will provide knowledge about the feasibility of leveraging existing resources in routine primary care and potential benefits of adding supportive community-facing roles to improve hypertension care and reduce disparities. TRIAL REGISTRATION: Clinicaltrials.govNCT02674464.
RCT Entities:
Disparities in the control of hypertension and other cardiovascular disease risk factors are well-documented in the United States, even among patients seen regularly in the healthcare system. Few existing approaches explicitly address disparities in hypertension care and control. This paper describes the RICH LIFE Project (Reducing Inequities in Care of Hypertension: Lifestyle Improvement for Everyone) design. METHODS:RICH LIFE is a two-arm, cluster-randomized trial, comparing the effectiveness of enhanced standard of care, "Standard of Care Plus" (SCP), to a multi-level intervention, "Collaborative Care/Stepped Care" (CC/SC), for improving blood pressure (BP) control and patient activation and reducing disparities in BP control among 1890 adults with uncontrolled hypertension and at least one other cardiovascular disease risk factor treated at 30 primary care practices in Maryland and Pennsylvania. Fifteen practices randomized to the SCP arm receive standardized BP measurement training; race/ethnicity-specific audit and feedback of BP control rates; and quarterly webinars in management practices, quality improvement and disparities reduction. Fifteen practices in the CC/SC arm receive the SCP interventions plus implementation of the collaborative care model with stepped-care components (community health worker referrals and virtual specialist-panel consults). The primary clinical outcome is BP control (<140/90 mm Hg) at 12 months. The primary patient-reported outcome is change from baseline in self-reported patient activation at 12 months. DISCUSSION: This study will provide knowledge about the feasibility of leveraging existing resources in routine primary care and potential benefits of adding supportive community-facing roles to improve hypertension care and reduce disparities. TRIAL REGISTRATION: Clinicaltrials.govNCT02674464.
Authors: David C Goff; Donald M Lloyd-Jones; Glen Bennett; Sean Coady; Ralph B D'Agostino; Raymond Gibbons; Philip Greenland; Daniel T Lackland; Daniel Levy; Christopher J O'Donnell; Jennifer G Robinson; J Sanford Schwartz; Susan T Shero; Sidney C Smith; Paul Sorlie; Neil J Stone; Peter W F Wilson; Harmon S Jordan; Lev Nevo; Janusz Wnek; Jeffrey L Anderson; Jonathan L Halperin; Nancy M Albert; Biykem Bozkurt; Ralph G Brindis; Lesley H Curtis; David DeMets; Judith S Hochman; Richard J Kovacs; E Magnus Ohman; Susan J Pressler; Frank W Sellke; Win-Kuang Shen; Sidney C Smith; Gordon F Tomaselli Journal: Circulation Date: 2013-11-12 Impact factor: 29.690
Authors: Joseph L Dieleman; Ranju Baral; Maxwell Birger; Anthony L Bui; Anne Bulchis; Abigail Chapin; Hannah Hamavid; Cody Horst; Elizabeth K Johnson; Jonathan Joseph; Rouselle Lavado; Liya Lomsadze; Alex Reynolds; Ellen Squires; Madeline Campbell; Brendan DeCenso; Daniel Dicker; Abraham D Flaxman; Rose Gabert; Tina Highfill; Mohsen Naghavi; Noelle Nightingale; Tara Templin; Martin I Tobias; Theo Vos; Christopher J L Murray Journal: JAMA Date: 2016-12-27 Impact factor: 56.272
Authors: Eve A Kerr; Brian J Zikmund-Fisher; Mandi L Klamerus; Usha Subramanian; Mary M Hogan; Timothy P Hofer Journal: Ann Intern Med Date: 2008-05-20 Impact factor: 25.391
Authors: Jeffrey S Gonzalez; Mark Peyrot; Lauren A McCarl; Erin Marie Collins; Luis Serpa; Matthew J Mimiaga; Steven A Safren Journal: Diabetes Care Date: 2008-12 Impact factor: 17.152
Authors: Chidinma A Ibe; Carmen Alvarez; Kathryn A Carson; Jill A Marsteller; Deidra C Crews; Katherine B Dietz; Raquel C Greer; Lee Bone; Lisa A Cooper Journal: Ethn Dis Date: 2021-01-21 Impact factor: 1.847
Authors: Carmen Alvarez; Anika L Hines; Kathryn A Carson; Nadia Andrade; Chidinma A Ibe; Jill A Marsteller; Lisa A Cooper Journal: Ethn Dis Date: 2021-01-21 Impact factor: 1.847
Authors: Carmen Alvarez; Chidinma Ibe; Katie Dietz; Nicolas Dominguez Carrero; Gideon Avornu; Ruth-Alma Turkson-Ocran; Jagriti Bhattarai; Deidra Crews; Paula Darby Lipman; Lisa A Cooper Journal: J Ambul Care Manage Date: 2022 Jul-Sep 01
Authors: Carmen Alvarez; Holly Sims; Kimesha Grant; Jessica Walczak; Paula Darby Lipman; Jill A Marsteller; Lisa A Cooper Journal: Int J Environ Res Public Health Date: 2022-03-11 Impact factor: 3.390