Uncontrolled Hypertension
Conditions
Keywords
Best Practice Clinic-Based Care;, telehealth care, uncontrolled hypertension
Brief summary
The goal of this observational pragmatic study is to learn about how evidence-based interventions and best practices for management of uncontrolled hypertension can be integrated across a large healthcare system through the use of virtual and clinic-based care approaches. The primary outcome for this work is the sustained change over time in patients' reported blood pressure readings relative to guidelines-based thresholds for treatment. Measures in all domains of the RE-AIM (reach, effectiveness, adoption, Implementation and Maintenance) implementation science framework will be used.
Detailed description
The overall purpose of this project is to study the implementation of the organization's PCORI Hypertension Care Management (PHCM) program and evaluate its impact on patients' health and experiences with care. Patients will be offered two different clinical pathways to manage their uncontrolled hypertension (hybrid \[telehealth + in-person clinic visits\], or telehealth only). Both of these approaches are evidence-based. Their effectiveness in relation to health outcomes will be examined. Data will be analyzed to provide context to the quantitative RE-AIM findings and to capture information on outcomes that cannot be collected by other means. This protocol includes both program evaluation activities conducted by the health system and research activities conducted by the study team to generate generalizable knowledge about patient experiences and outcomes. Part 1: Program Evaluation Aims: 1\. Conduct an evaluation of the reach, effectiveness, adoption, implementation, and maintenance of the telehealth care and clinic-based care interventions using a mixed-methods, real-world approach supported by the RE-AIM framework. Part 2: Qualitative Component of Study (Anticipated enrollment numbers on this site reflect this portion of the study) Research Aims: 1. Identify how patients describe changes in their self-management behaviors, confidence, health beliefs, and relationships with care teams as they engage in the care approaches. 2. Examine how patients and healthcare staff describe their experiences with the implementation strategies used to deliver the PCHM program across diverse settings.
Interventions
None listed
Sponsors
Colleen J Klein
Study design
Observational model
OTHER
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Has a hypertension diagnosis code; 2 or more blood pressure readings greater than or equal to 130 mmHg systolic or diastolic greater than or equal to 80 mmHg.
Exclusion criteria
* Enrolled in the OSF Saint Francis Medical Center Hypertension Center. * Under the care of a palliative or hospice care team * pregnant patients * patients residing in nursing homes * patients with end-stage renal disease
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Systolic Blood Pressure Change | Trajectory over 12 months and 24 months | Average change in systolic blood pressure between baseline, 12 Months and 24 months (mm Hg) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Diastolic Blood Pressure Change | Trajectory over 12 months and 24 months | change in patient diastolic blood pressure change from baseline |
| Symptom Reporting (Side effects of Antihypertensive Medication) | Baseline to 6 months | • Number of Participants Reporting Dizziness, Hypotension or fainting as a Side Effect of Antihypertensive Medication at Six Months |
| Patient Care Experience | baseline to 6 months | Number of Participants Who Report High Level of Satisfaction With Hypertension Care at Six Months. |
| Self-monitoring/Confidence in Self-Care | baseline to 6 months | Number of patients reporting confidence in managing hypertension (Blood Pressure Care Survey) at Six Months |
| Qualitive Interviews with Patients | baseline to 6 months, 12, months, 18 months, and 24 months | Patients' experiences over time in program (longitudinal interviews) - purposive sample |
| Provider and Staff Interviews | baseline, 6 months, 12 months, 18 months, and 24 months. | Qualitative interviews will provide descriptions of experiences pre-, mid- and later phase implementation to provide insights into staff and organizational factors influencing uptake and success of PHCM interventions. |
| Unplanned Care Visits | baseline to 6 months | Unplanned care visits due to high blood pressure, change in blood pressure, blood pressure control rate |
Countries
United States
Contacts
PRINCIPAL_INVESTIGATORColleen Klein, PhD, APRN, FNP-BC
OSF HealthCare
PRINCIPAL_INVESTIGATORMelinda Cooling, DNP, APRN, FAANP
OSF HealthCare
Outcome results
None listed