Hypertension
Conditions
Brief summary
The proposed study Project IMPACT: CHW Intervention is part of a larger study examining the efficacy, adoption, and impact of integrated EHR-based decision-support and physician feedback interventions with community health worker (CHW)-led self-management and coaching support for South Asian patients with uncontrolled hypertension. This is a randomized control intervention utilizing community health worker (CHW)-led self-management and coaching support for South Asian patients with uncontrolled hypertension at PCP clinics in New York City.
Detailed description
The Goal of this study is that: 1. EHR-based decision support and performance feedback interventions will be more effective in improving hypertension control for South Asian patients than standard care; 2. A combined EHR-CHW intervention will be more effective in improving hypertension control for South Asian patients compared to standard care and the EHR-based intervention Investigators hope to implement and assess the efficacy of CHW-led coaching through promotion of team-based care and use of culturally tailored education to improve hypertension control and mitigate risk factors related to CVD among South Asian patients with uncontrolled hypertension. Study findings can provide translatable and scalable models for other limited English proficient communities.
Interventions
BEHAVIORALCHW Intervention
Patients randomized to Group A will be invited to attend 4 more group educational sessions on self-management immediately.CHWs will follow up with participants by phone or in person through a home or clinic visit. At these follow-up meetings, CHWs will engage in goal-setting activities regarding changes to health behaviors, medication adherence, or other issues related to hypertension control as identified jointly by the patient and CHW. CHWs will also collect height, weight, and blood pressure measurements at initial and in-person follow-up visits. The CHW will make necessary referrals to other services available in the community (i.e. exercise classes, social services, mental health, tobacco cessation, etc.).
BEHAVIORALWait List Control Group
4 education sessions beginning 6-12 months later.
Sponsors
NYU Langone Health
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Intervention model description
Step wedge design, whereby 5 groups of 3 practices will implement the intervention in phases.
Eligibility
Sex/Gender
ALL
Age
18 Years to 85 Years
Healthy volunteers
No
Inclusion criteria
CHW Intervention * Diagnosis of hypertension or at least two systolic blood pressure measurements of 140 mm Hg or greater, or at least two diastolic BP 90 mm Hg or greater in the past 12 months. Focus Group * Any clinical patients meeting the inclusion criteria for the CHW Intervention who participated in the CHW Intervention Pilot Round.
Exclusion criteria
* Pregnant patients are excluded. * No children or vulnerable subjects will be enrolled in this study.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Percent of current diagnosed hypertensive patients with BP <140/90 (or BP<130/80 for patients with diabetes) at 6 Months | 6 Months |
| Percent of current diagnosed hypertensive patients with BP <140/90 (or BP<130/80 for patients with diabetes) at 12 months | 12 months |
| Percent of patients with HbA1c <7 (for patients with hypertension + diabetes) at 6 months | 6 months |
Secondary
| Measure | Time frame |
|---|---|
| Percent of current hypertensive patients receiving counseling on BMI, diet and physical activity | 12 months |
| Percent of patients with diagnosis of hypertension with a BP measure taken in the past 6 months | 6 months |
| Percent of current diagnosed hypertensive patients who smoke who have been referred for smoking cessation | 12 months |
| Percent of current diagnosed hypertensive patients referred to a nutritionist in the past year | 12 months |
| Percent of patients without hypertension having valid BP measurement, last 12 months | 12 months |
| Percent of current hypertensive patients screened for diabetes in last year | 12 months |
Countries
United States
Outcome results
None listed